Organization · NPI-2

Dva Vha Richmond

Podiatrist · Richmond, VA

NPI number1043733546
StatusActive
Last updated in NPPESJul 18, 2017

Details

NPI
1043733546
Entity type
Organization (NPI-2)
Legal business name
Dva Vha Richmond
Organization subpart
No
Enumeration date
Jul 18, 2017
Last updated
Jul 18, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213E00000X Podiatrist0116031054VAYes

Practice location

1201 Broad Rock Blvd
Richmond, VA 23249-0001

Phone 804-675-5000

Mailing address

4112 Whitford Cir Apt 206
Glen Allen, VA 23060-4164

Phone 516-424-3745

Authorized official

Johnathan Brantley
Podiatrist
8046755000

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