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General NPI Number Information
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NPI Number | 1184662769
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Entity Type | Organization
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Legal Business Name | VIRGINIA INTERVENTIONAL PAIN SPECIALISTS, PC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7603 FOREST AVE COURTYARD BUILDING, HENRICO DRS. HOSPITAL
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City | RICHMOND
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State | VA
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Zip | 23229-4944
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Country | US
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Telephone | 804-282-6160
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Fax | 804-282-3120
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Provider Business Mailing Address
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Address Line | PO BOX 1269
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-8269
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Country | US
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Telephone | 804-282-6160
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Fax | 804-282-3120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL C MARTIN
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Credential | M.D.
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Telephone | 804-282-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101040954
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License Number State | VA
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