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General NPI Number Information
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NPI Number | 1801874821
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Entity Type | Individual
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Provider Name | NIRMALA VASA MD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | SOUTHSIDE VIRGINIA TRAINING CENTER 26317 WEST WASHINGTON STREET EXT
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City | PETERSBURG
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State | VA
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Zip | 23803-0030
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Country | US
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Telephone | 804-524-7294
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Fax | 804-524-7030
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Provider Business Mailing Address
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Address Line | SOUTHSIDE VIRGINIA TRAINING CENTER 26317 WEST WASHINGTON STREET EXT
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City | PETERSBURG
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State | VA
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Zip | 23803-0030
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Country | US
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Telephone | 804-524-7294
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Fax | 804-524-7030
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101034736
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License Number State | VA
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