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General NPI Number Information
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NPI Number | 1174136337
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Entity Type | Organization
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Legal Business Name | VIRTUAL CONSULT MD LLC
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 2202 HWY 41 NORTH UNIT E 152
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City | HENDERESON
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State | KY
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Zip | 42420
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Country | US
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Telephone | 812-848-2322
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Fax | 812-727-5469
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Provider Business Mailing Address
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Address Line | 1222 PROFESSIONAL BLVD
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City | EVANSVILLE
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State | IN
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Zip | 47714-8002
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Country | US
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Telephone | 812-720-3800
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Fax | 812-727-5469
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Authorized Official
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Title or Position | OWNER
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Name | DR. NEIL JARIWALA
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Credential | MD
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Telephone | 678-200-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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