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General NPI Number Information
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NPI Number | 1053638890
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Entity Type | Organization
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Legal Business Name | MARYVIEW HOSPITAL
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 4037 TAYLOR RD STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5500
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Country | US
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Telephone | 757-483-1403
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Fax | 757-483-3757
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Provider Business Mailing Address
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Address Line | 8580 MAGELLAN PKWY
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City | RICHMOND
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State | VA
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Zip | 23227-1149
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Country | US
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Telephone | 804-627-5462
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Fax | 866-449-0896
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Authorized Official
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Title or Position | CFO
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Name | STEPHAN QUIRICONI
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Credential |
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Telephone | 804-281-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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