Healthcare Provider Details

I. General information

NPI: 1336384494
Provider Name (Legal Business Name): RICHMOND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 TAYLOR RD
CHESAPEAKE VA
23321-2201
US

IV. Provider business mailing address

5000 COX RD STE 100
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 757-215-1800
  • Fax: 757-215-1821
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-965-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number213000508
License Number StateVA

VIII. Authorized Official

Name: MR. MARVIN W. BRIDGERS III
Title or Position: DIRECTOR OF PHARMACY
Credential: R.PH.
Phone: 804-968-5700