MEDICARE: DR. MICHAEL RAYMOND KEVERLINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101230614	VA
2	332H00000X	Eyewear Supplier	7010360	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4773409	OTHER	VA	CIGNA
4	29717	OTHER	VA	OPTIMA
5	102064	OTHER	VA	ANTHEM BCBS
6	2174956	OTHER	VA	UNITED HEALTH CARE
7	399105	OTHER	VA	MAMSI
8	7827286	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1962401612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RAYMOND KEVERLINE MD

Provider Business Mailing Address
First Line	:	3206 CHURCHLAND BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5206
Country	:	US
Telephone Number	:	757-484-0101
Fax Number	:	757-484-0515

Provider Business Practice Location Address
First Line	:	3206 CHURCHLAND BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5206
Country	:	US
Telephone Number	:	757-484-0101
Fax Number	:	757-484-0515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/08/2008

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