Provider Demographics
NPI:1336567601
Name:CARVER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CARVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 E VIRGINIA BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2824
Mailing Address - Country:US
Mailing Address - Phone:757-261-5000
Mailing Address - Fax:757-962-5610
Practice Address - Street 1:6251 E VIRGINIA BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2824
Practice Address - Country:US
Practice Address - Phone:757-261-5000
Practice Address - Fax:757-962-5610
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
VA0101267342208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program