Healthcare Provider Details

I. General information

NPI: 1316944531
Provider Name (Legal Business Name): JOSEPH WELDON BOATWRIGHT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E CLAY ST
RICHMOND VA
23219-1325
US

IV. Provider business mailing address

PO BOX 26591
RICHMOND VA
23261-6591
US

V. Phone/Fax

Practice location:
  • Phone: 804-643-8914
  • Fax:
Mailing address:
  • Phone: 804-643-8914
  • Fax: 804-643-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101029134
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: