Healthcare Provider Details

I. General information

NPI: 1932527355
Provider Name (Legal Business Name): VIRGILUS OZOUDE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AUBREYS LOOP
SOUTH BOSTON VA
24592-5054
US

IV. Provider business mailing address

101 AUBREYS LOOP
SOUTH BOSTON VA
24592-5054
US

V. Phone/Fax

Practice location:
  • Phone: 434-517-3879
  • Fax: 434-517-3989
Mailing address:
  • Phone: 434-517-3879
  • Fax: 434-517-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102204899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: