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NPI Code Detail

MEDICARE: EMILY A REVENSON PAC

MEDICARE: EMILY A REVENSON PAC
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
1363A00000XPhysician Assistant0110002789VA
2363AM0700XMedical Physician Assistant0110002789VA

General Provider Information

NPI Number : 1508026089
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY A REVENSON PAC
Provider Business Mailing Address
First Line : 1000 BOULDERS PKWY
Second Line : SUITE 102
City : RICHMOND
State : VA
Zip : 23225-5545
Country : US
Telephone Number : 804-320-4243
Fax Number : 804-622-0552
Provider Business Practice Location Address
First Line : 6600 W BROAD ST STE 300
Second Line :
City : RICHMOND
State : VA
Zip : 23230-1710
Country : US
Telephone Number : 804-320-4243
Fax Number : 804-622-0552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2008
Last Update Date : 05/20/2021

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Directions to “ EMILY A REVENSON PAC” Practice Location

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