Healthcare Provider Details

I. General information

NPI: 1699988170
Provider Name (Legal Business Name): ANDREW J VORENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 FOREST AVE SUITE 308
RICHMOND VA
23229-4938
US

IV. Provider business mailing address

7605 FOREST AVE SUITE 308
RICHMOND VA
23229-4938
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-7077
  • Fax:
Mailing address:
  • Phone: 804-288-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116018383
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101245399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: