Healthcare Provider Details

I. General information

NPI: 1184786428
Provider Name (Legal Business Name): VIRGINIA CHILD NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 700
RICHMOND VA
23226
US

IV. Provider business mailing address

5875 BREMO RD SUITE 700
RICHMOND VA
23226
US

V. Phone/Fax

Practice location:
  • Phone: 804-673-9600
  • Fax: 804-673-8021
Mailing address:
  • Phone: 804-673-9600
  • Fax: 804-673-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number0101016858
License Number StateVA

VIII. Authorized Official

Name: MR. RONALD D DAVID
Title or Position: MEDICAL DOCTOR OWNER
Credential: MD
Phone: 804-673-9600