MEDICARE: MARYVIEW HOSPITAL

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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1104851104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	8580 MAGELLAN PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-627-5462
Fax Number	:	866-449-0896

Provider Business Practice Location Address
First Line	:	1040 UNIVERSITY BLVD STE 205
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-2650
Country	:	US
Telephone Number	:	757-484-2272
Fax Number	:	757-484-4620

Authorized Official
Title or Position	:	CFO
Name	:	STEPHAN QUIRICONI
Credential	:
Telephone Number	:	804-281-8301

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/29/2019

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Directions to “MARYVIEW HOSPITAL ” Practice Location

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