Provider Demographics
NPI:1467427773
Name:MATAWARAN, RAMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:A
Last Name:MATAWARAN
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 1:1232 PERIMETER PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5924
Mailing Address - Country:US
Mailing Address - Phone:757-975-4695
Mailing Address - Fax:757-852-0699
Practice Address - Street 1:1232 PERIMETER PKWY STE 206
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5924
Practice Address - Country:US
Practice Address - Phone:757-975-4695
Practice Address - Fax:757-852-0699
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005841224Medicaid
E46392Medicare UPIN
VA005841224Medicaid