Healthcare Provider Details

I. General information

NPI: 1467465104
Provider Name (Legal Business Name): COLETTE MOUSSALLI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 THREE CHOPT ROAD STE 201
RICHMOND VA
23229-4601
US

IV. Provider business mailing address

8921 THREE CHOPT ROAD STE 201
RICHMOND VA
23229-4601
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-9315
  • Fax: 804-288-5332
Mailing address:
  • Phone: 804-285-9315
  • Fax: 804-288-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: COLETTE MOUSSALLI
Title or Position: PRESIDENT
Credential: MD
Phone: 804-285-4315