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NPI Code Detail

MEDICARE: NANCY MACCONNACHIE, PH.D., INC.

MEDICARE: NANCY MACCONNACHIE, PH.D., INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist00810001700VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080290OTHERVASOUTHERN HEALTH/SENTARA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3177062OTHERVAANTHEM BCBS

General Provider Information

NPI Number : 1003869546
Entity Type Code : Organization
Provider Name (Legal Business Name) : NANCY MACCONNACHIE, PH.D., INC.
Provider Business Mailing Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Provider Business Practice Location Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Authorized Official
Title or Position : PRESIDENT
Name : DR. NANCY MACCONNACHIE
Credential : PH.D.
Telephone Number : 804-264-0966
Provider Enumeration Date : 05/18/2006
Last Update Date : 06/21/2010

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