Provider Demographics
NPI:1730183484
Name:ZEEVI, GARY REUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:REUBEN
Last Name:ZEEVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:MOB SOUTH, SUITE G-5
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3934
Mailing Address - Fax:757-388-2957
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:MOB SOUTH, SUITE G-5
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-287-7840
Practice Address - Fax:804-287-7845
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038086174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
204838OtherBLUE CROSS BLUE SHIELD
497780OtherAETNA
VA5817234Medicaid
VAC06778OtherGROUP PTAN
060000883Medicare PIN
204838OtherBLUE CROSS BLUE SHIELD