Healthcare Provider Details

I. General information

NPI: 1558407338
Provider Name (Legal Business Name): VIRGINIA THORACIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 BREMO RD SUITE 103
RICHMOND VA
23226-2442
US

IV. Provider business mailing address

2004 BREMO RD SUITE 103
RICHMOND VA
23226-2442
US

V. Phone/Fax

Practice location:
  • Phone: 804-565-0383
  • Fax: 804-565-0389
Mailing address:
  • Phone: 804-565-0383
  • Fax: 804-565-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101052545
License Number StateVA

VIII. Authorized Official

Name: PETER D BUCKMAN
Title or Position: OWNER, PRESIDENT
Credential: MD
Phone: 804-565-0383