Healthcare Provider Details

I. General information

NPI: 1417257585
Provider Name (Legal Business Name): RICHMOND INTERNISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 OTTERBURN RD
MOSELEY VA
23120-1262
US

IV. Provider business mailing address

PO BOX 1967
MIDLOTHIAN VA
23113-1967
US

V. Phone/Fax

Practice location:
  • Phone: 804-614-6758
  • Fax: 815-361-7461
Mailing address:
  • Phone: 804-614-6758
  • Fax: 815-361-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101237749
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101237749
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101237749
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101237749
License Number StateVA

VIII. Authorized Official

Name: DR. HASAN M YOUSUF
Title or Position: OWNER
Credential: MD MPH
Phone: 804-614-6758