Healthcare Provider Details

I. General information

NPI: 1699513390
Provider Name (Legal Business Name): ENDOMD HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY STE 300
RICHMOND VA
23233-1339
US

IV. Provider business mailing address

8401 MAYLAND DR
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 571-480-6053
  • Fax:
Mailing address:
  • Phone: 571-480-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARIM GINENA
Title or Position: OFFICE MANAGER
Credential:
Phone: 571-480-6053