Healthcare Provider Details

I. General information

NPI: 1932266400
Provider Name (Legal Business Name): VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STONY POINT PKWY
RICHMOND VA
23235-1900
US

IV. Provider business mailing address

PO BOX 758997
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberH1875
License Number StateVA

VIII. Authorized Official

Name: DOMINIC J PULEO
Title or Position: CFO
Credential:
Phone: 804-828-1295