Healthcare Provider Details

I. General information

NPI: 1629269139
Provider Name (Legal Business Name): L. GLENN CHRISTIE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 FOREST AVE STE 402
RICHMOND VA
23229-4939
US

IV. Provider business mailing address

7605 FOREST AVE STE 402
RICHMOND VA
23229-4939
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-7872
  • Fax: 804-288-4318
Mailing address:
  • Phone: 804-282-7872
  • Fax: 804-288-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101013228
License Number StateVA

VIII. Authorized Official

Name: DR. LAURENCE GLENN CHRISTIE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 804-282-7872