Provider Demographics
NPI:1558330845
Name:RAMOS, OTILIO JR (PA)
Entity Type:Individual
Prefix:MR
First Name:OTILIO
Middle Name:
Last Name:RAMOS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:1239 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7103
Practice Address - Country:US
Practice Address - Phone:757-549-9935
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10011482POtherSENTARA OPTIMA
VA1558330845Medicaid
VAP00424850Medicare PIN
VA012517E30Medicare PIN
VAQ76344Medicare UPIN