Healthcare Provider Details

I. General information

NPI: 1790779759
Provider Name (Legal Business Name): ANNE MARIE MCMORROW TUOHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6372 MECHANICSVILLE TPKE SUITE 103
MECHANICSVILLE VA
23111-4705
US

IV. Provider business mailing address

6372 MECHANICSVILLE TPKE SUITE 103
MECHANICSVILLE VA
23111-4705
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-4690
  • Fax: 804-559-0333
Mailing address:
  • Phone: 804-730-4690
  • Fax: 804-559-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101254644
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number43075
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number64739
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: