Basic Information
Provider Information | |||||||||
NPI: | 1649341678 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DUMARAN | ||||||||
FirstName: | RAYMUND | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4041 TAYLOR RD | ||||||||
Address2: | SUITE G | ||||||||
City: | CHESAPEAKE | ||||||||
State: | VA | ||||||||
PostalCode: | 233215525 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574845828 | ||||||||
FaxNumber: | 7574844371 | ||||||||
Practice Location | |||||||||
Address1: | 4041 TAYLOR RD | ||||||||
Address2: | SUITE G | ||||||||
City: | CHESAPEAKE | ||||||||
State: | VA | ||||||||
PostalCode: | 233215525 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574845828 | ||||||||
FaxNumber: | 7574844371 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2006 | ||||||||
LastUpdateDate: | 04/01/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101052406 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 6063381 | 05 | VA |   | MEDICAID | 0000000003812 | 01 | VA | ANTHEM BCBS GROUP NUMBER | OTHER | 101433 | 01 | VA | CIGNA HEALTHCARE | OTHER | 22241 | 01 | VA | SENTARA OPTIMA OF VIRGINA | OTHER | 076715 | 01 | VA | ANTHEM BCBS OF VA | OTHER | 200144 | 01 | VA | SENTARA OPTIMA VENDOR # | OTHER |