Provider Demographics
NPI:1558353656
Name:HOMAN, RICHARD V (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:HOMAN
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10088115OtherOPTIMA HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VA1558353656OtherVIRGINIA PREMIER HEALTH PLAN
VA1558353656OtherCOVENTRY HEATLH CARE/SOUTHERN HEALTH
NC5919579Medicaid
VAPAROtherCIGNA
VA-002OtherTRICARE/CHAMPUS
VA1558353656OtherUNITED HEALTHCARE
VA456746OtherANTHEM BC/BS
VAPAROtherAETNA
VAPAROtherCORVEL
VAPAROtherVIRGINIA HEALTH NETWORK
VA1558353656Medicaid
VAPAROtherUSA MANAGED CARE
VA456746OtherANTHEM BC/BS