Healthcare Provider Details

I. General information

NPI: 1700445673
Provider Name (Legal Business Name): VIRGINIA HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16313 FALCONERS TER
MOSELEY VA
23120-1655
US

IV. Provider business mailing address

PO BOX 17830
RICHMOND VA
23226-7830
US

V. Phone/Fax

Practice location:
  • Phone: 804-554-6134
  • Fax: 804-681-7102
Mailing address:
  • Phone: 804-554-6134
  • Fax: 804-681-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALTORY MUSNI MIRANDA JR.
Title or Position: OWNER
Credential: MD
Phone: 804-554-6134