Provider Demographics
NPI:1790474716
Name:CATES, MARVIN R (HIS)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:R
Last Name:CATES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 JOHN ROLFE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-8111
Mailing Address - Country:US
Mailing Address - Phone:804-353-9780
Mailing Address - Fax:
Practice Address - Street 1:2048 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-353-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002070237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist