Healthcare Provider Details

I. General information

NPI: 1194778506
Provider Name (Legal Business Name): ALEXANDER K. GIREVENDULIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 BUFORD ROAD
RICHMOND VA
23832
US

IV. Provider business mailing address

2602 BUFORD ROAD
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-272-8806
  • Fax: 804-272-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number101028853
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101028853
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number0101028853
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: