MEDICARE: CENTRAL VIRGINIA OCCUHEALTH, P.C.

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	2083X0100X	Occupational Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09637	OTHER		MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1780643718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VIRGINIA OCCUHEALTH, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 11768
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-0168
Country	:	US
Telephone Number	:	804-353-4000
Fax Number	:	804-213-9783

Provider Business Practice Location Address
First Line	:	2621 GROVE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4308
Country	:	US
Telephone Number	:	804-254-5467
Fax Number	:	804-254-9898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY D. MCGOWAN
Credential	:	M.D.
Telephone Number	:	804-254-5467

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	08/22/2020

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