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General NPI Number Information
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NPI Number | 1659501187
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Entity Type | Organization
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Legal Business Name | PRIMEDOC OF RICHMOND PC
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 1500 N 28TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5332
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Country | US
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Telephone | 804-225-1701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60446
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City | CHARLOTTE
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State | NC
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Zip | 28260-0446
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Country | US
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Telephone | 828-210-3260
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Fax | 828-255-7623
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT REYNOLDS
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Credential | MD
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Telephone | 828-210-3260
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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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