Provider Demographics
NPI:1346298072
Name:CAULEY, DEAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:C
Last Name:CAULEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 A GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517
Mailing Address - Country:US
Mailing Address - Phone:757-640-0022
Mailing Address - Fax:757-627-8064
Practice Address - Street 1:1909 A GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517
Practice Address - Country:US
Practice Address - Phone:757-640-0022
Practice Address - Fax:757-627-8064
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA72851OtherOPTIMA
VA010054435Medicaid
VA103766OtherANTHEM
VA72851OtherOPTIMA