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General NPI Number Information
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NPI Number | 1447365945
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA ONCOLOGY, INC.
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 700 S SYCAMORE ST STE 10
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City | PETERSBURG
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State | VA
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Zip | 23803
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Country | US
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Telephone | 804-732-7900
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Fax | 804-732-7592
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Provider Business Mailing Address
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Address Line | 700 S SYCAMORE ST STE 10
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City | PETERSBURG
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State | VA
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Zip | 23803
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Country | US
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Telephone | 804-732-7900
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Fax | 804-732-7592
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Authorized Official
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Title or Position | PRES, UP, SEC, TREAS
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Name | DR. DONNA MAE FUKUMOTO
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Credential | MD
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Telephone | 804-732-7900
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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 | 0101030480
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License Number State | VA
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