Basic Information
| Provider Information | |||||||||
| NPI: | 1033145073 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AMAKER | ||||||||
| FirstName: | RAYMOND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 KANAWAH RUN | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236932762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578674919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 J CLYDE MORRIS BLVD | ||||||||
| Address2: | HAMPTON ROADS NEONATOLOGY | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575942000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 0101053890 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6728821 | 05 | VA | MEDICAID |