1134593494 NPI number — VIRGINIA GASTROENTEROLOGY INSTITUTE PC

Table of content: (NPI 1134593494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134593494 NPI number — VIRGINIA GASTROENTEROLOGY INSTITUTE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA GASTROENTEROLOGY INSTITUTE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134593494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4017 RIVER PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-3356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 FAIRVIEW DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23851-1226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-942-2566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MALIK
Authorized Official First Name:
PRAMOD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-942-2566

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  01010231641 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com