Healthcare Provider Details

I. General information

NPI: 1144630195
Provider Name (Legal Business Name): REBECCA SUZANNE KAISER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7016 LEE PARK RD STE 100
MECHANICSVILLE VA
23111-3620
US

IV. Provider business mailing address

201 CONCOURSE BLVD STE 200
GLEN ALLEN VA
23059-5640
US

V. Phone/Fax

Practice location:
  • Phone: 804-549-4040
  • Fax: 804-549-4032
Mailing address:
  • Phone: 804-549-4040
  • Fax: 804-549-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101264118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: