Healthcare Provider Details

I. General information

NPI: 1477956878
Provider Name (Legal Business Name): VIRGINIA COMMONWEALTH UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W FRANKLIN ST
RICHMOND VA
23284-9012
US

IV. Provider business mailing address

821 W FRANKLIN ST
RICHMOND VA
23284-9012
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0100
  • Fax:
Mailing address:
  • Phone: 804-828-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LAWLESS
Title or Position: MD
Credential: MD
Phone: 804-828-0100