Healthcare Provider Details

I. General information

NPI: 1619138823
Provider Name (Legal Business Name): ANDREW D. MUNRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 10/26/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 GASKINS RD
HENRICO VA
23233-1441
US

IV. Provider business mailing address

3855 GASKINS RD STE 203
HENRICO VA
23233-1441
US

V. Phone/Fax

Practice location:
  • Phone: 804-217-6363
  • Fax: 804-217-6400
Mailing address:
  • Phone: 804-290-4278
  • Fax: 508-910-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number0101262869
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101262869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: