Healthcare Provider Details

I. General information

NPI: 1558368100
Provider Name (Legal Business Name): RICHARD W MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

110 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8672
US

IV. Provider business mailing address

110 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8672
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-5160
  • Fax: 434-977-5202
Mailing address:
  • Phone: 434-977-5160
  • Fax: 434-977-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101038523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: