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General NPI Number Information
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NPI Number | 1629367131
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Entity Type | Individual
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Provider Name | SAMUEL LLEWELLYN CASELLA M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1000 E BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23219-1930
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Country | US
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Telephone | 804-628-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 E BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23219-1930
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101268256
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License Number State | VA
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