Healthcare Provider Details

I. General information

NPI: 1356505291
Provider Name (Legal Business Name): ALFREDO I URDANETA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE ST RONC: RADIATION ONCOLOGY
RICHMOND VA
23298-5017
US

IV. Provider business mailing address

PO BOX 980058 RONC: RADIATION ONCOLOGY
RICHMOND VA
23298-0058
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7238
  • Fax:
Mailing address:
  • Phone: 804-828-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022444
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101256304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: