Provider Demographics
NPI:1518924810
Name:VALENTINE, RICHARD NELSON JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NELSON
Last Name:VALENTINE
Suffix:JR
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 1:700 INDEPENDENCE CIR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6405
Mailing Address - Country:US
Mailing Address - Phone:757-473-2021
Mailing Address - Fax:757-518-1110
Practice Address - Street 1:700 INDEPENDENCE CIR
Practice Address - Street 2:SUITE 3A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6405
Practice Address - Country:US
Practice Address - Phone:757-473-2021
Practice Address - Fax:757-518-1110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA01010131884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA095844OtherBLUE CROSS BLUE SHIELD
VA6259456Medicaid
VA603950OtherVIRGINIA PREMIER
VAM9307OtherKEY ADVANTAGE
VA1439620OtherCIGNA
VA214650OtherMAMSI
VA34009OtherSENTARA HEALTH PLAN
VA603950OtherVIRGINIA PREMIER