Healthcare Provider Details

I. General information

NPI: 1427664374
Provider Name (Legal Business Name): ELIJAH TOZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 PATTERSON AVE STE E
RICHMOND VA
23229-6755
US

IV. Provider business mailing address

2617 DOGTOWN RD
GOOCHLAND VA
23063-2421
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-7992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2102002523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: