Healthcare Provider Details

I. General information

NPI: 1659501187
Provider Name (Legal Business Name): PRIMEDOC OF RICHMOND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N 28TH ST
RICHMOND VA
23223-5332
US

IV. Provider business mailing address

PO BOX 60446
CHARLOTTE NC
28260-0446
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-1701
  • Fax:
Mailing address:
  • Phone: 828-210-3260
  • Fax: 828-255-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT REYNOLDS
Title or Position: PRESIDENT
Credential: MD
Phone: 828-210-3260