Healthcare Provider Details

I. General information

NPI: 1821007584
Provider Name (Legal Business Name): MELHORN AND MELHORN, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SANTA ROSA RD SUITE 103
RICHMOND VA
23229-5109
US

IV. Provider business mailing address

1504 SANTA ROSA RD SUITE 103
RICHMOND VA
23229-5109
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6414
  • Fax: 804-288-9022
Mailing address:
  • Phone: 804-288-6414
  • Fax: 804-288-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. FREDERICK ROBERT MELHORN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 804-288-6414