Provider Demographics
NPI:1326148735
Name:CLOUD, ROSE J (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:J
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:J
Other - Last Name:CHEMPLAVIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-988-0085
Mailing Address - Fax:757-989-3511
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:SUITE 1 C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4435
Practice Address - Country:US
Practice Address - Phone:757-988-0085
Practice Address - Fax:757-989-3511
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032889208000000X
FLME65332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00672302-1Medicaid
VA00672302-1Medicaid