Healthcare Provider Details

I. General information

NPI: 1902617442
Provider Name (Legal Business Name): AB OPTIMAL MEDICALCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12013 IVY HOLLOW CT
GLEN ALLEN VA
23059-7531
US

IV. Provider business mailing address

12013 IVY HOLLOW CT
GLEN ALLEN VA
23059-7531
US

V. Phone/Fax

Practice location:
  • Phone: 804-929-2421
  • Fax: 804-282-9133
Mailing address:
  • Phone: 804-929-2421
  • Fax: 804-282-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANISH J BADODARIYA
Title or Position: PRESIDENT SOLE OWNER
Credential: MD
Phone: 804-929-2421