Healthcare Provider Details

I. General information

NPI: 1467420885
Provider Name (Legal Business Name): RICHARD D SIIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE SUITE 120
NEWPORT NEWS VA
23606-2565
US

IV. Provider business mailing address

9 RICHLAND MEDICAL PARK SUITE 330
COLUMBIA SC
29203-6859
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-1060
  • Fax: 757-594-1066
Mailing address:
  • Phone: 800-290-5309
  • Fax: 803-434-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101227524
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number0101227524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: