Healthcare Provider Details

I. General information

NPI: 1245499276
Provider Name (Legal Business Name): VIRGINIA INSTITUTE OF PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE SUITE 210
RICHMOND VA
23229-4920
US

IV. Provider business mailing address

7611 FOREST AVE SUITE 210
RICHMOND VA
23229-4920
US

V. Phone/Fax

Practice location:
  • Phone: 804-290-0909
  • Fax: 804-290-0333
Mailing address:
  • Phone: 804-290-0909
  • Fax: 804-290-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101236442
License Number StateVA

VIII. Authorized Official

Name: BURTON SUNDIN
Title or Position: CEO
Credential: MD
Phone: 804-290-0909