Healthcare Provider Details

I. General information

NPI: 1376535013
Provider Name (Legal Business Name): MARYANN J KAVESKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 605
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

1602 ROLLING HILLS DR SUITE 201
RICHMOND VA
23229-5012
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8806
  • Fax: 804-288-6079
Mailing address:
  • Phone: 804-282-5822
  • Fax: 804-282-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101042861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: