Healthcare Provider Details

I. General information

NPI: 1740580273
Provider Name (Legal Business Name): GENERAL VASCULAR AND TRANSPLANT CONSULTANTS OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE SUITE 300
HENRICO VA
23229-4946
US

IV. Provider business mailing address

7611 FOREST AVE SUITE 300
HENRICO VA
23229-4946
US

V. Phone/Fax

Practice location:
  • Phone: 804-968-4435
  • Fax: 804-968-4463
Mailing address:
  • Phone: 804-968-4435
  • Fax: 804-968-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERARDO MENDEZ-PICON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-968-4435