Healthcare Provider Details

I. General information

NPI: 1649239476
Provider Name (Legal Business Name): INFECTIOUS DISEASE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 FOREST AVE SUITE 410
RICHMOND VA
23229-4938
US

IV. Provider business mailing address

PO BOX 11768
RICHMOND VA
23230-0168
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-1833
  • Fax: 804-285-5754
Mailing address:
  • Phone: 804-672-4835
  • Fax: 804-213-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W BROOKS JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 804-285-1833