Healthcare Provider Details

I. General information

NPI: 1497755136
Provider Name (Legal Business Name): RICHARD L CAUDELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 BOULEVARD STE B
COLONIAL HEIGHTS VA
23834-1345
US

IV. Provider business mailing address

3660 BOULEVARD STE B
COLONIAL HEIGHTS VA
23834-1345
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-4144
  • Fax: 804-520-4144
Mailing address:
  • Phone: 804-520-4144
  • Fax: 804-520-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: