MEDICARE: RICHMOND MICROSURGEONS, LLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1194556043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND MICROSURGEONS, LLC

Provider Business Mailing Address
First Line	:	14401 SOMMERVILLE CT STE 1A
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-6914
Country	:	US
Telephone Number	:	804-285-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	14401 SOMMERVILLE CT STE 1A
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-6914
Country	:	US
Telephone Number	:	804-285-4115
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JILLIAN MARCHANT
Credential	:
Telephone Number	:	804-477-8255

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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