Healthcare Provider Details

I. General information

NPI: 1962791160
Provider Name (Legal Business Name): DANA MICHELE SOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23224-4915
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD
RICHMOND VA
23224-4915
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone: 804-675-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101258511
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: