Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0116031621 | VA |
NPI | 1083055487 |
---|---|
Provider Name | Michele Richard |
First Address | Richmond, VA 23223-6945 |
Second Address | Richmond, VA 23298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2013 |
Last Update Date | 10/07/2018 |