Healthcare Provider Details

I. General information

NPI: 1700434420
Provider Name (Legal Business Name): CENTRAL VIRGINIA GYNECOLOGIC ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 STONY POINT DR # 3300
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

1401 JOHNSTON WILLIS DR STE 1100
NORTH CHESTERFIELD VA
23235-4730
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-5040
  • Fax: 804-272-0526
Mailing address:
  • Phone: 804-323-5040
  • Fax: 804-323-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LYNN SEGURA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 804-323-5040