Healthcare Provider Details

I. General information

NPI: 1568423473
Provider Name (Legal Business Name): RAJWINDER SINGH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK BLVD
PETERSBURG VA
23805-9274
US

IV. Provider business mailing address

PO BOX 17978
RICHMOND VA
23226-7978
US

V. Phone/Fax

Practice location:
  • Phone: 804-765-5060
  • Fax: 804-765-6015
Mailing address:
  • Phone: 804-288-4453
  • Fax: 804-288-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101235282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: