Healthcare Provider Details

I. General information

NPI: 1619363058
Provider Name (Legal Business Name): ELIZABETH DEXTER-RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W MAIN STREET FLOOR 6
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-5500
  • Fax: 434-244-4480
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101265076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: