Healthcare Provider Details

I. General information

NPI: 1750354379
Provider Name (Legal Business Name): RADU TEODOR IONESCU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIR RM 2C
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

100 SENTARA CIR RM 2C
WILLIAMSBURG VA
23188-5713
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-7218
  • Fax: 757-984-7210
Mailing address:
  • Phone: 757-984-7218
  • Fax: 757-984-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101237450
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101237450
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: