Healthcare Provider Details

I. General information

NPI: 1609930478
Provider Name (Legal Business Name): VIRGINIA PAIN MANAGEMENT CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SENTARA CIRCLE
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

PO BOX 12212
NEWPORT NEWS VA
23612-2212
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-4400
  • Fax: 757-345-4401
Mailing address:
  • Phone: 757-867-6101
  • Fax: 757-867-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: TUSHAR UMAKANT GAJJAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-345-4385