MEDICARE: DIMMOCK MEDICAL GROUP

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1225769300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMMOCK MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 11768
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-0168
Country	:	US
Telephone Number	:	804-524-0060
Fax Number	:	804-524-0064

Provider Business Practice Location Address
First Line	:	325 CHARLES H DIMMOCK PKWY STE 500
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2988
Country	:	US
Telephone Number	:	804-524-0060
Fax Number	:	804-524-0064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AKSHAY S DAVE
Credential	:	MD
Telephone Number	:	804-524-0060

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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