Healthcare Provider Details

I. General information

NPI: 1063754554
Provider Name (Legal Business Name): WESTHAMPTON HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BREMO RD # 205A
RICHMOND VA
23226-2440
US

IV. Provider business mailing address

2000 BREMO RD # 205A
RICHMOND VA
23226-2440
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-0510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL E BACKER
Title or Position: OWNER
Credential: MD
Phone: 804-285-0510