Active NPI
William J Duane, PHD
- Clinical Psychologist
- Chesapeake, VA
National Provider Identifier
1003809500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810000926
- Practice address
- 4041 Taylor Rd Ste G
Chesapeake, VA 23321-5525 - Phone
- (757) 483-6404
- Fax
- (757) 483-0737
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810000926 | VA | Primary |
Addresses
Primary practice location
4041 Taylor Rd Ste G
Chesapeake, VA 23321-5525
Mailing address
4041 Taylor Rd Ste G
Chesapeake, VA 23321-5525
Phone (757) 483-6404
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007799187 | Medicaid | VA | |
| 027830 | Other | VA | ANTHEM |
| 080704 | Other | VA | SENTARA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810000926 | VA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Physician Services Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatry Physician
- Portsmouth, VA
- NPI 1821421454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636243200000",
"number": "1003809500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4041 TAYLOR RD STE G",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233215525",
"telephone_number": "757-483-6404",
"fax_number": "757-483-0737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4041 TAYLOR RD STE G",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233215525",
"telephone_number": "757-483-6404",
"fax_number": "757-483-0737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUANE",
"first_name": "WILLIAM",
"middle_name": "J",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-30",
"last_updated": "2021-11-07",
"certification_date": "2021-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810000926",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007799187",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "027830",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SENTARA",
"identifier": "080704",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.