Healthcare Provider Details

I. General information

NPI: 1063783538
Provider Name (Legal Business Name): APEX MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2012
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 TWIN HICKORY RD SUITE A
GLEN ALLEN VA
23059-5682
US

IV. Provider business mailing address

5310 TWIN HICKORY RD STE A
GLEN ALLEN VA
23059-5783
US

V. Phone/Fax

Practice location:
  • Phone: 804-237-0010
  • Fax:
Mailing address:
  • Phone: 804-237-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RUMKI BANERJEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 804-273-0010