Healthcare Provider Details

I. General information

NPI: 1023018363
Provider Name (Legal Business Name): SHAWN M BORICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 ROCKBRIDGE ST STE 103
RICHMOND VA
23230-4333
US

IV. Provider business mailing address

3200 ROCKBRIDGE ST STE 103
RICHMOND VA
23230-4333
US

V. Phone/Fax

Practice location:
  • Phone: 804-386-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101234495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: