Healthcare Provider Details

I. General information

NPI: 1154832582
Provider Name (Legal Business Name): WELLCOMEMD RICHMOND CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GASKINS RD STE A
RICHMOND VA
23238-1480
US

IV. Provider business mailing address

2500 GASKINS ROAD SUITE A
RICHMOND VA
23238
US

V. Phone/Fax

Practice location:
  • Phone: 804-774-7099
  • Fax: 804-528-5864
Mailing address:
  • Phone: 804-774-7099
  • Fax: 804-528-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101102633
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101102633
License Number StateVA

VIII. Authorized Official

Name: DR. NEAL H CARL
Title or Position: PHYSICIAN
Credential: MD
Phone: 804-774-7099