Healthcare Provider Details

I. General information

NPI: 1265742225
Provider Name (Legal Business Name): JOSEPH E MCKEOWN MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N RIDGE RD SUITE 100
RICHMOND VA
23229-7404
US

IV. Provider business mailing address

420 N RIDGE RD SUITE 100
RICHMOND VA
23229-7404
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-0101
  • Fax: 804-288-0850
Mailing address:
  • Phone: 804-288-0101
  • Fax: 804-288-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101042576
License Number StateVA

VIII. Authorized Official

Name: DR. JOSEPH E MCKEOWN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 804-288-0101