Provider Demographics
NPI:1669482758
Name:OCCUPATIONAL MEDICINE, EDUCATION AND RESEARCH SERVICES, LLC
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE, EDUCATION AND RESEARCH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-9406
Mailing Address - Street 1:932 PROFESSIONAL PL
Mailing Address - Street 2:#201
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3631
Mailing Address - Country:US
Mailing Address - Phone:757-481-9406
Mailing Address - Fax:757-389-5889
Practice Address - Street 1:932 PROFESSIONAL PL
Practice Address - Street 2:#201
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3631
Practice Address - Country:US
Practice Address - Phone:757-481-9406
Practice Address - Fax:757-389-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010372152083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty