MEDICARE: VIRGILUS OZOUDE D.O.

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	207Q00000X	Family Medicine Physician	0102204899	VA

General Provider Information

NPI Number	:	1932527355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGILUS OZOUDE D.O.

Provider Business Mailing Address
First Line	:	101 AUBREYS LOOP
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-5054
Country	:	US
Telephone Number	:	434-517-3879
Fax Number	:	434-517-3989

Provider Business Practice Location Address
First Line	:	101 AUBREYS LOOP
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-5054
Country	:	US
Telephone Number	:	434-517-3879
Fax Number	:	434-517-3989

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	11/20/2020

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