Healthcare Provider Details

I. General information

NPI: 1649748807
Provider Name (Legal Business Name): MR. AARONDE INGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8812 MOUNT OLIVE AVE
GLEN ALLEN VA
23060-3919
US

IV. Provider business mailing address

10 S 20TH ST APT U310
RICHMOND VA
23223-7276
US

V. Phone/Fax

Practice location:
  • Phone: 804-300-3988
  • Fax:
Mailing address:
  • Phone: 804-300-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberT67120180
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberT67120180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: