Healthcare Provider Details

I. General information

NPI: 1528149846
Provider Name (Legal Business Name): SUSAN G KORNSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL STREET PSYCHIATRY
RICHMOND VA
23298-0510
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-8950
  • Fax: 804-327-8822
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101040047
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: