Healthcare Provider Details

I. General information

NPI: 1104845809
Provider Name (Legal Business Name): DARRIELLE VALERIE BLUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD CHIPPENHAM HOSPITAL
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7101 JAHNKE RD CHIPPENHAM HOSPITAL
RICHMOND VA
23225-4017
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-3911
  • Fax:
Mailing address:
  • Phone: 804-320-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301081907
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101243337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: