Healthcare Provider Details

I. General information

NPI: 1215040928
Provider Name (Legal Business Name): ROCKWELL PHYSICIANS OF SALISBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 PAGEHURST DR
MIDLOTHIAN VA
23113-6411
US

IV. Provider business mailing address

2410 PAGEHURST DR
MIDLOTHIAN VA
23113-6411
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-6140
  • Fax: 804-897-6141
Mailing address:
  • Phone: 804-897-6140
  • Fax: 804-897-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101052275
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101052275
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. WILLIAM KEVIN WATTERSON
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 804-897-6140