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General NPI Number Information
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NPI Number | 1184668477
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 10079 KINGS HIGHWAY
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City | KING GEORGE
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State | VA
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Zip | 22485-3445
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Country | US
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Telephone | 540-775-3111
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Fax | 540-775-3109
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Provider Business Mailing Address
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Address Line | 608 JACKSON STREET
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5719
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Country | US
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Telephone | 540-899-4797
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Fax | 540-899-4599
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BROOKE W ROSSHEIM
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Credential | M.D., M.P.H
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Telephone | 540-899-4797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | VA
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