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General NPI Number Information
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NPI Number | 1639127962
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Entity Type | Organization
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Legal Business Name | RICHMOND GASTROENTEROLOGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 165 WADSWORTH DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-4500
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Country | US
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Telephone | 804-330-4901
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Fax | 804-330-9141
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Provider Business Mailing Address
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Address Line | 165 WADSWORTH DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-4500
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Country | US
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Telephone | 804-330-4901
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Fax | 804-330-9141
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MS. SHELLEY COLON
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Credential |
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Telephone | 804-330-4901
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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 | 207RG0100X
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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