Individual provider · NPI-1
Dr. Raymond Joseph Clydesdale, D.O.
Preventive Medicine, Aerospace Medicine · Hampton, VA
NPI number1699764340
StatusActive
Last updated in NPPESJun 12, 2024
Details
- NPI
- 1699764340
- Entity type
- Individual (NPI-1)
- Name
- Dr. Raymond Joseph Clydesdale
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 17, 2005
- Certification date
- Jun 4, 2024
- Last updated
- Jun 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2083A0100X | Preventive Medicine, Aerospace Medicine | OS12364 | PA | Yes |
| 2083X0100X | Preventive Medicine, Occupational Medicine | OS12364 | PA | |
| 208D00000X | General Practice | OS12364 | PA |
Practice location
633 Medical Group77 Nealy Avenue
Hampton, VA 23665-2040
Phone 757-225-7630
Mailing address
633 Medical Group77 Nealy Avenue
Langley Afb, VA 23665
Other practice locations
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