Healthcare Provider Details

I. General information

NPI: 1063094209
Provider Name (Legal Business Name): MR. REGINALD KWAO OSARDU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF SURGERY RESIDENCY, 980135 1201 E. MARSHALL ST.
RICHMOND VA
23298
US

IV. Provider business mailing address

VCUHS GMEA BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7874
  • Fax: 804-827-1016
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: