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General NPI Number Information
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NPI Number | 1538878285
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Entity Type | Organization
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Legal Business Name | KRV MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 5700 FITZHUGH AVE
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City | RICHMOND
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State | VA
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Zip | 23226-1800
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Country | US
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Telephone | 908-279-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 12342 SMITH GROVE CT
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City | GLEN ALLEN
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State | VA
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Zip | 23059-7176
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Country | US
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Telephone | 908-279-5086
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISHNA VANAM
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Credential | DO
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Telephone | 908-279-5086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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