MEDICARE: ROYAL CARE MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101029968	VA

General Provider Information

NPI Number	:	1528392586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL CARE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3900 WESTERRE PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 WESTERRE PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1478
Country	:	US
Telephone Number	:	804-503-1149
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID M CORCORAN
Credential	:
Telephone Number	:	804-503-1149

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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Directions to “ROYAL CARE MEDICAL CENTER INC ” Practice Location

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