Healthcare Provider Details

I. General information

NPI: 1831292325
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SANDYHOOK RD
GOOCHLAND VA
23063-0178
US

IV. Provider business mailing address

PO BOX 178 1800 SANDYHOOK RD
GOOCHLAND VA
23063-0178
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-5843
  • Fax: 804-556-3707
Mailing address:
  • Phone: 804-556-5843
  • Fax: 804-556-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM T TWEEL JR.
Title or Position: DISTRICT DIRECTOR
Credential: MD
Phone: 804-556-5843