Healthcare Provider Details

I. General information

NPI: 1851863815
Provider Name (Legal Business Name): VIRGINIA CANCER INSTITUTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 HARBOURSIDE CENTRE LOOP SUITE 101
MIDLOTHIAN VA
23112-2170
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-378-0394
  • Fax: 804-739-7649
Mailing address:
  • Phone: 804-391-4171
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: PABLO M GONZALEZ
Title or Position: PRESIDENT/MANAGING PARTNER
Credential: MD
Phone: 804-330-7990