Professional Place Medical Group, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0101037215 Issued in VA

Legal business name

PROFESSIONAL PLACE MEDICAL GROUP, LLC

Practice address

932 Professional PL
#201
Chesapeake, VA 23320-3631

Phone

(757) 481-9406

Fax

(757) 389-5889

NPI assigned

Aug 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Craven, MD

Title

Member/Owner

Phone

(757) 481-9406

Specialties & licenses 1

Addresses

Other names 1

• East Coast Clinical Research, LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114937372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 PROFESSIONAL PL",
            "address_2": "#201",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203631",
            "telephone_number": "757-481-9406",
            "fax_number": "757-389-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "932 PROFESSIONAL PL",
            "address_2": "#201",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203631",
            "telephone_number": "757-481-9406",
            "fax_number": "757-389-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PLACE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRAVEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "757-481-9406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101037215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Coast Clinical Research, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• General Practice Physician in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• General Practice Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.