Healthcare Provider Details

I. General information

NPI: 1417976218
Provider Name (Legal Business Name): ANTHONY JOSEPH MINISI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD. MCGUIRE V.A. MEDICAL CENTER
RICHMOND VA
23249
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD. MCGUIRE V.A. MEDICAL CENTER
RICHMOND VA
23249
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5614
  • Fax: 804-675-5420
Mailing address:
  • Phone: 804-675-5614
  • Fax: 804-675-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101033419
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101033419
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101033419
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: