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NPI Code Detail

MEDICARE: RICHMOND IOP, PLC

MEDICARE: RICHMOND IOP, PLC
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
1174400000XSpecialist580VA

General Provider Information

NPI Number : 1861516940
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHMOND IOP, PLC
Provider Business Mailing Address
First Line : 10049 MIDLOTHIAN TPKE
Second Line : SUITE B2
City : RICHMOND
State : VA
Zip : 23235-4859
Country : US
Telephone Number : 804-320-8032
Fax Number : 804-323-0602
Provider Business Practice Location Address
First Line : 10049 MIDLOTHIAN TPKE
Second Line : SUITE B2
City : RICHMOND
State : VA
Zip : 23235-4859
Country : US
Telephone Number : 804-320-8032
Fax Number : 804-323-0602
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. GAIL E. SANTARELLI
Credential : LPC, LSATP, NCC
Telephone Number : 804-320-8032
Provider Enumeration Date : 03/16/2007
Last Update Date : 03/24/2008

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