Healthcare Provider Details

I. General information

NPI: 1164485876
Provider Name (Legal Business Name): VIRGINIA UROLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 STONY POINT DR
RICHMOND VA
23235-2002
US

IV. Provider business mailing address

9101 STONY POINT DR
RICHMOND VA
23235-2002
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-9105
  • Fax: 804-287-6119
Mailing address:
  • Phone: 804-330-9105
  • Fax: 804-287-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIGETTE BOOTH
Title or Position: COO
Credential:
Phone: 804-287-6100