Healthcare Provider Details

I. General information

NPI: 1992770051
Provider Name (Legal Business Name): RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 EMMET STREET SOUTH
CHARLOTTESVILLE VA
22904-4270
US

IV. Provider business mailing address

417 EMMET STREET, SOUTH P.O. BOX 400270
CHARLOTTESVILLE VA
22904-4270
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-7034
  • Fax: 434-924-4621
Mailing address:
  • Phone: 434-924-7034
  • Fax: 434-924-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH BELLAH
Title or Position: CLINICAL ADMINISTRATOR
Credential:
Phone: 434-924-7034