Provider Demographics
NPI:1578724175
Name:CLAUSSEN, KEITH A (DO)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:CLAUSSEN
Suffix:
Gender:M
Credentials:DO
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:2008-06-17
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578724175OtherTRICARE/CHAMPUS
VA1578724175OtherCIGNA
VA1578724175OtherVIRGINIA HEALTH NETWORK
VA1578724175OtherHUMANA
VA1578724175OtherMULTIPLAN
VA1578724175OtherUSA MANAGED CARE
VA1578724175OtherCORVEL
VA1578724175OtherAETNA
VA1578724175Medicaid
VA1578724175OtherUNITED HEALTHCARE
VA1578724175OtherVIRGINIA PREMIER HEALTH PLAN
VA1578724175OtherANTHEM BC/BS
NC1578724175Medicaid
VA1578724175OtherCORVEL
VAVVN179AMedicare PIN