Provider Demographics
NPI:1821559535
Name:OWEN, CORA ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:ELAINE
Last Name:OWEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:ELAINE
Other - Last Name:SCRUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3370 PUMP RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1130
Practice Address - Country:US
Practice Address - Phone:804-360-8061
Practice Address - Fax:804-595-1456
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine