Healthcare Provider Details

I. General information

NPI: 1770936650
Provider Name (Legal Business Name): VIRGINIA CANCER INSTITUTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 DISCOVERY DR STE A
RICHMOND VA
23229-8605
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-322-1590
  • Fax: 804-673-6028
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-673-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201004713
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEABORN MCDONALD WADE III
Title or Position: AUTH OFFICIAL
Credential: MD
Phone: 804-559-2489