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General NPI Number Information
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NPI Number | 1427530583
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Entity Type | Organization
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Legal Business Name | PATRONUS HEALTH LLC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 4870 SADLER RD STE 300
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6294
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Country | US
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Telephone | 757-524-2304
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 452
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-0452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LINDSEY NEAL
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Credential | MD
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Telephone | 757-524-2304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101246851
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 0101246851
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License Number State | VA
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