Healthcare Provider Details

I. General information

NPI: 1730130980
Provider Name (Legal Business Name): VIRGINIA CANCER INSTITUTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/16/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 DISCOVERY DR STE A
RICHMOND VA
23229-8605
US

IV. Provider business mailing address

7202 GLEN FOREST DR SUITE 200
RICHMOND VA
23226-3781
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-673-2731
Mailing address:
  • Phone: 804-391-4171
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: PABLO M GONZALEZ
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 804-391-4171