Healthcare Provider Details

I. General information

NPI: 1023731676
Provider Name (Legal Business Name): SASA MITROVIC NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

10813 PORTER PARK LN
GLEN ALLEN VA
23059-8043
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-7644
  • Fax:
Mailing address:
  • Phone: 804-484-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number0024185229
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: