Healthcare Provider Details

I. General information

NPI: 1417957598
Provider Name (Legal Business Name): JOHN A PATRIZIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 PUMP RD
RICHMOND VA
23233-1130
US

IV. Provider business mailing address

13520 REYNARD LN
RICHMOND VA
23233-7652
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-8061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101037883
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101037883
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: