Healthcare Provider Details

I. General information

NPI: 1962938779
Provider Name (Legal Business Name): KRISTIN LEE HULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/25/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARSHALL ST
RICHMOND VA
23298-5028
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-9734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3144
  • Fax: 804-628-7104
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101269109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: