Healthcare Provider Details

I. General information

NPI: 1184566861
Provider Name (Legal Business Name): WILLIAM ALDEN BOTTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

1200 E BROAD ST # 980257
RICHMOND VA
23298-5025
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax:
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116042448
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: