Healthcare Provider Details

I. General information

NPI: 1841283660
Provider Name (Legal Business Name): GUNVOR E WEIRICK-SACKS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4687 POUNCEY TRACT RD
GLEN ALLEN VA
23059-5802
US

IV. Provider business mailing address

4687 POUNCEY TRACT RD
GLEN ALLEN VA
23059-5802
US

V. Phone/Fax

Practice location:
  • Phone: 804-422-5437
  • Fax: 804-474-9071
Mailing address:
  • Phone: 804-422-5437
  • Fax: 804-474-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101043918
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043918
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: