Healthcare Provider Details

I. General information

NPI: 1699727099
Provider Name (Legal Business Name): MARIANO M PIEDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 STONY POINT PKWY STE 240
RICHMOND VA
23235
US

IV. Provider business mailing address

9020 STONY POINT PKWY STE 240
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-5236
  • Fax:
Mailing address:
  • Phone: 804-282-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101036168
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: