Healthcare Provider Details

I. General information

NPI: 1790762235
Provider Name (Legal Business Name): JOSEPH R VILSECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13510 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-2626
US

IV. Provider business mailing address

13510 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-2626
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-9477
  • Fax: 804-794-1973
Mailing address:
  • Phone: 804-794-9477
  • Fax: 804-794-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101021733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: