Healthcare Provider Details

I. General information

NPI: 1255651303
Provider Name (Legal Business Name): SEAN CHRISTOPHER SLUSHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23224-4915
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD
RICHMOND VA
23224-4915
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax: 804-675-6473
Mailing address:
  • Phone: 804-675-5000
  • Fax: 804-675-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101256423
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101256423
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: