Healthcare Provider Details

I. General information

NPI: 1619892890
Provider Name (Legal Business Name): MAYANK KORPAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 E SOUTHSIDE PLAZA
RICHMOND VA
23224
US

IV. Provider business mailing address

1200 EAST BROAD STREET, 6TH FLOOR, SOUTH WING BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-7777
  • Fax: 804-230-2071
Mailing address:
  • Phone: 804-828-9783
  • Fax: 804-828-5613

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: