Healthcare Provider Details

I. General information

NPI: 1285494021
Provider Name (Legal Business Name): MICHAEL BEJARANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

VCUHS GME ADMINISTRATION, BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4097
  • Fax: 804-828-5533
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102209467
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: