Provider Demographics
NPI:1699735514
Name:EASTERN VIRGINIA RHEUMATOLOGY PLC
Entity type:Organization
Organization Name:EASTERN VIRGINIA RHEUMATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-595-2040
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-545-6862
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:11747 JEFFERSON AVE
Practice Address - Street 2:SUITE 4E
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1998
Practice Address - Country:US
Practice Address - Phone:757-595-2040
Practice Address - Fax:757-591-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006031455Medicaid
VA006031455Medicaid
VAC47466Medicare UPIN
VAC47466Medicare PIN