Active NPI
Raymond Joseph Clydesdale, D.O.
- Aerospace Medicine Physician
- Hampton, VA
National Provider Identifier
1699764340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- OS12364
- Practice address
- 633 Medical Group
77 Nealy Avenue
Hampton, VA 23665-2040 - Phone
- (757) 225-7630
- NPI assigned
- Oct 17, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | OS12364 | PA | |
| General Practice Physician | 208D00000X | OS12364 | PA | |
| Aerospace Medicine Physician | 2083A0100X | OS12364 | PA | Primary |
Addresses
Primary practice location
633 Medical Group
77 Nealy Avenue
Hampton, VA 23665-2040
Mailing address
633 Medical Group
77 Nealy Avenue
Langley Afb, VA 23665
Other practice location 1
375 Medical Group
310 W. Losey Street
Scott AFB, IL 62225
Phone (618) 256-9355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS12364 | PA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718150400000",
"number": "1699764340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 MEDICAL GROUP",
"address_2": "77 NEALY AVENUE",
"city": "LANGLEY AFB",
"state": "VA",
"postal_code": "23665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 MEDICAL GROUP",
"address_2": "77 NEALY AVENUE",
"city": "HAMPTON",
"state": "VA",
"postal_code": "236652040",
"telephone_number": "757-225-7630"
}
],
"practiceLocations": [
{
"address_1": "375 Medical Group",
"address_2": "310 W. Losey Street",
"address_purpose": "LOCATION",
"city": "Scott AFB",
"state": "IL",
"postal_code": "62225",
"country_code": "US",
"telephone_number": "618-256-9355",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLYDESDALE",
"first_name": "RAYMOND",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2024-06-12",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "PA",
"license": "OS12364",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PA",
"license": "OS12364",
"primary": false
},
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "PA",
"license": "OS12364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampton, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.