=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760542591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENRICO DOCTORS NEUROLOGY ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7607 FOREST AVE STE 300
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-228-2742
-----------------------------------------------------
Fax | 804-288-9053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 HEALTH PARK DR
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-4692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-373-7406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | SUZANNE BERGAMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-446-9440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------