Provider Demographics
NPI:1275978017
Name:SHOEMAKER, REBECCA RYAN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RYAN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 THIMBLE SHOALS BLVD STE 803
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-933-8888
Practice Address - Fax:757-806-6320
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00116028976208VP0000X
VA01012639402081P2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6731883OtherUNITED HEALTHCARE
VA6731883OtherMAMSI
VA1275978017OtherDEPT OF LABOR
VA1275978017Medicaid
VA670633OtherBLUE CROSS BLUE SHIELD