MEDICARE: DR. AMENRA F TUASON MD

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	2084F0202X	Forensic Psychiatry Physician	0101041739	VA

General Provider Information

NPI Number	:	1457339558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMENRA F TUASON MD

Provider Business Mailing Address
First Line	:	PO BOX 11768
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-0168
Country	:	US
Telephone Number	:	804-281-3319
Fax Number	:	804-213-9773

Provider Business Practice Location Address
First Line	:	CENTRAL STATE HOSPITAL
Second Line	:	WASHINGTON ST
City	:	PETERSBURG
State	:	VA
Zip	:	23803-0030
Country	:	US
Telephone Number	:	804-524-4700
Fax Number	:	804-524-4717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	12/03/2021

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