Individual
DR. NAU DEAVIN DOMAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5855 BREMO ROAD, SUITE 207, RICHMOND, VA 23226-1930
(804) 288-3079
(804) 282-6159
Mailing address
5855 BREMO ROAD, SUITE 207, RICHMOND, VA 23226-1930
(804) 288-3079
(804) 282-6159
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101245571
VA
207R00000X
Internal Medicine Physician
4301091486
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05700
GROUP PTAN
—
01
—
C06695
GROUP PTAN
VA
01
—
C06778
GROUP PTAN
VA
Enumeration date
04/02/2008
Last updated
02/17/2014
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