Raven B Custalow (NPI# 1669955019, PAC ID# 0840543013) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1669955019 |
| PAC ID by PECOS | 0840543013 |
| Professional Enrollment ID | I20181106000339 |
| Full Name | Raven B Custalow |
| Organization Legal Name | RIVERSIDE PHYSICIAN SERVICES INC |
| Address |
17452 Richmond Rd Callao VA 22435-2420 |
| Phone Number | 8045296141 |
| Gender | F |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 5092608448 |
| Number of Group Practice Members | 581 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490084 | RIVERSIDE TAPPAHANNOCK HOSPITAL |
| 491308 | RAPPAHANNOCK GENERAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 17452 Richmond Rd, Callao, VA 22435-2420 | 8045296141 | RIVERSIDE PHYSICIAN SERVICES INC |
| Organization Legal Name | RIVERSIDE PHYSICIAN SERVICES INC |
| Physicians | 606 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer Alene Keith | Nurse Practitioner | Riverside Physician Services Inc | 209 Village Ave, Suite P, Tabb, VA 23693-5639 |
| Aarika L Turner | Nurse Practitioner | Riverside Physician Services Inc | 1500 Commonwealth Ave, Williamsburg, VA 23185-5229 |
| Priscilla A Bullen | Nurse Practitioner | Riverside Physician Services Inc | 12 Bruton Ave, Newport News, VA 23601-1602 |
| Hemchand Ramberan | Gastroenterology | Riverside Physician Services Inc | 101 Philip Roth St, Suite 5 A, Newport News, VA 23606-1393 |
| Scott Kaufman | Cardiac Electrophysiology | Riverside Physician Services Inc | 7544 Hospital Dr, Suite 202a, Gloucester, VA 23061-4178 |
| Jorge Rodolfo Rivera-irias | Critical Care (intensivists) | Riverside Physician Services Inc | 20486 Market St, Onancock, VA 23417-4309 |
| Dawn Marie Brown | General Surgery | Riverside Physician Services Inc | 109 Philip Roth St, Newport News, VA 23606-1393 |
| Prakash Mohan Kafle | Infectious Disease | Riverside Physician Services Inc | 12420 Warwick Blvd, 4c Riverside Infectious Disease Specialists, Newport News, VA 23606-3001 |
| Molly Massey | Nurse Practitioner | Riverside Physician Services Inc | 4917 Richmond Tappahannock Hwy 1, Aylett, VA 23009-3416 |
| Ajay Singh Rathore | Nephrology | Riverside Physician Services Inc | 739 Thimble Shoals Blvd, Suite 801, Newport News, VA 23606-3585 |
| Street Address |
17452 RICHMOND RD |
| City | CALLAO |
| State | VA |
| Zip | 22435-2420 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lisa C Jenkins Haynie | Family Medicine | Riverside Physician Services Inc | 17452 Richmond Rd, Callao, VA 22435-2420 |
| Donna L Lamarque-ambrose | Family Medicine | Riverside Physician Services Inc | 17452 Richmond Rd, Callao, VA 22435-2420 |
| Linda K Mitchell | Nurse Practitioner | Riverside Physician Services Inc | 17452 Richmond Rd, Callao, VA 22435-2420 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Merthia I Haynie | Physical Therapy | 765 Northumberland Hwy, Callao, VA 22435-2206 |
| City | CALLAO |
| Zip Code | 22435 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | CALLAO + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Raven B Custalow.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.