Healthcare Provider Details

I. General information

NPI: 1629005830
Provider Name (Legal Business Name): JULIE LEFTWICH BEALES M.D., PHD.D, M.S.H.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

3925 NORTHLAKE DR
RICHMOND VA
23233
US

V. Phone/Fax

Practice location:
  • Phone: 804-364-4746
  • Fax:
Mailing address:
  • Phone: 804-675-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101056288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: