Provider Demographics
NPI: | 1952774416 |
---|---|
Name: | CAREMORE HEALTH PLAN |
Entity Type: | Organization |
Organization Name: | CAREMORE HEALTH PLAN |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | NEIDERER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 804-767-8300 |
Mailing Address - Street 1: | 8935 PATTERSON AVENUE |
Mailing Address - Street 2: | |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23229 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-767-8300 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8935 PATTERSON AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | RICHMOND |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23229 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-767-8300 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-11-05 |
Last Update Date: | 2015-11-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 102203303 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |