Healthcare Provider Details

I. General information

NPI: 1033642194
Provider Name (Legal Business Name): EVAN JACOB KRAUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE STE 200
HENRICO VA
23229-4946
US

IV. Provider business mailing address

1212 KOGER CENTER BLVD
NORTH CHESTERFIELD VA
23235-4778
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-2100
  • Fax:
Mailing address:
  • Phone: 804-897-2100
  • Fax: 804-897-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101271365
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: