Provider Demographics
NPI:1588660880
Name:ROSENBLUM, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:ROSENBLUM
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 1:2829 SHORE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1498
Mailing Address - Country:US
Mailing Address - Phone:757-734-1000
Mailing Address - Fax:757-734-1001
Practice Address - Street 1:2829 SHORE DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1498
Practice Address - Country:US
Practice Address - Phone:757-734-1000
Practice Address - Fax:757-734-1001
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225952208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2022039691Medicaid
VA216254OtherANTHEM
7006139OtherAETNA
600215028OtherCIGNA
VA6901531Medicaid
26107OtherOPTIMA
VA6901531Medicaid