Healthcare Provider Details

I. General information

NPI: 1174136337
Provider Name (Legal Business Name): VIRTUAL CONSULT MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 HWY 41 NORTH UNIT E 152
HENDERESON KY
42420
US

IV. Provider business mailing address

1222 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8002
US

V. Phone/Fax

Practice location:
  • Phone: 812-848-2322
  • Fax: 812-727-5469
Mailing address:
  • Phone: 812-720-3800
  • Fax: 812-727-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL JARIWALA
Title or Position: OWNER
Credential: MD
Phone: 678-200-0048