Provider Demographics
NPI:1962401612
Name:KEVERLINE, MICHAEL RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:KEVERLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:RAYMOND
Other - Last Name:KEVERLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3206 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5206
Mailing Address - Country:US
Mailing Address - Phone:757-484-0101
Mailing Address - Fax:757-484-0515
Practice Address - Street 1:3206 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5206
Practice Address - Country:US
Practice Address - Phone:757-484-0101
Practice Address - Fax:757-484-0515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230614207W00000X
VA7010360332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8906674Medicaid
VA010080371Medicaid
VA4773409OtherCIGNA
VA29717OtherOPTIMA
VA102064OtherANTHEM BCBS
VA2174956OtherUNITED HEALTH CARE
VA399105OtherMAMSI
VA7827286OtherAETNA
VA753028236OtherTIN
VA753028236OtherTIN
VAP00089796Medicare ID - Type UnspecifiedRR MEDICARE
VA4773409OtherCIGNA
VAH50094Medicare UPIN