Healthcare Provider Details

I. General information

NPI: 1972692143
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E CARY ST
RICHMOND VA
23219-3816
US

IV. Provider business mailing address

400 E CARY ST
RICHMOND VA
23219-3816
US

V. Phone/Fax

Practice location:
  • Phone: 804-205-3746
  • Fax: 804-371-2253
Mailing address:
  • Phone: 804-205-3722
  • Fax: 804-371-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: DANNY TK AVULA
Title or Position: DIRECTOR OF PUBLIC HEALTH
Credential: MD, MPH
Phone: 804-205-3722