=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841424744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERSIDE REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10510 JEFFERSON AVE. SUID D BRENTWOOD OB GYN
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-594-4737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 J CLYDE MORRIS BLVD. RIVERSIDE REGIONAL MEDICAL CENTER
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-594-4737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OB-GYN RESIDENT
-----------------------------------------------------
Name | NIKUNJKUMAR MADHUBHAI RABADIYA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 757-594-4737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NW0100X
-----------------------------------------------------
Taxonomy Name | Women's Hospital
-----------------------------------------------------
License Number | 0116020091
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------