Healthcare Provider Details

I. General information

NPI: 1487701272
Provider Name (Legal Business Name): JAIME LYNNE BOHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 STONY POINT DR
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-327-8001
  • Fax: 804-327-8002
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101261479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: