Healthcare Provider Details

I. General information

NPI: 1336161710
Provider Name (Legal Business Name): JASVINDER SINGH DHILLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD ST. MARYS HOSPITAL PICU
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

5801 BREMO RD ST. MARYS HOSPITAL PICU
RICHMOND VA
23226-1907
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8222
  • Fax: 804-287-7460
Mailing address:
  • Phone: 804-281-8222
  • Fax: 804-287-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101233212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: