Healthcare Provider Details

I. General information

NPI: 1184668477
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10079 KINGS HIGHWAY
KING GEORGE VA
22485-3445
US

IV. Provider business mailing address

608 JACKSON STREET
FREDERICKSBURG VA
22401-5719
US

V. Phone/Fax

Practice location:
  • Phone: 540-775-3111
  • Fax: 540-775-3109
Mailing address:
  • Phone: 540-899-4797
  • Fax: 540-899-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. BROOKE W ROSSHEIM
Title or Position: DIRECTOR
Credential: M.D., M.P.H
Phone: 540-899-4797