Healthcare Provider Details

I. General information

NPI: 1609829175
Provider Name (Legal Business Name): CHARLES H COCKRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST RADIOLOGY
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

1250 E MARSHALL ST
RICHMOND VA
23298-5051
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6831
  • Fax: 804-628-1132
Mailing address:
  • Phone: 804-828-6831
  • Fax: 804-628-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: