Healthcare Provider Details

I. General information

NPI: 1073539805
Provider Name (Legal Business Name): CULLEN B. RIVERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BOULDERS PKWY SUITE 200
RICHMOND VA
23225-5545
US

IV. Provider business mailing address

1000 BOULDERS PKWY SUITE 102
RICHMOND VA
23225-5545
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4243
  • Fax: 804-622-0552
Mailing address:
  • Phone: 804-320-4243
  • Fax: 804-282-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101027498
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101027498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: