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General NPI Number Information
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NPI Number | 1780887232
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Entity Type | Individual
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Provider Name | BRIAN NICHOLAS SUDDARTH MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 1250 E MARSHALL ST
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City | RICHMOND
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State | VA
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Zip | 23298-5051
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Country | US
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Telephone | 804-828-9783
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 980615
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City | RICHMOND
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State | VA
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Zip | 23298-0615
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Country | US
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Telephone | 804-828-4880
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116017274
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 0101249247
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License Number State | VA
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