Provider Demographics
NPI:1003850223
Name:RIVERS, JEANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 112 SURGICAL SERVICE/MCGUIRE VAMC
Mailing Address - Street 2:1201 BROAD ROCK BLVD
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BOX 112 SURGICAL SERVICE/MCGUIRE VAMC
Practice Address - Street 2:1201 BROAD ROCK BLVD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABS4509975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG07921Medicare UPIN