Healthcare Provider Details

I. General information

NPI: 1508876111
Provider Name (Legal Business Name): JAMES R HEYWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 GROVE AVENUE
RICHMOND VA
23221
US

IV. Provider business mailing address

3603 GROVE AVENUE
RICHMOND VA
23221
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-2361
  • Fax: 804-359-0949
Mailing address:
  • Phone: 804-358-2361
  • Fax: 804-359-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101052104
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: