Healthcare Provider Details

I. General information

NPI: 1124140041
Provider Name (Legal Business Name): VYTAS KAZLAUSKAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY SUITE 302
RICHMOND VA
23233-1478
US

IV. Provider business mailing address

3900 WESTERRE PKWY SUITE 302
RICHMOND VA
23233-1478
US

V. Phone/Fax

Practice location:
  • Phone: 804-433-1040
  • Fax:
Mailing address:
  • Phone: 804-433-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101039407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: