Provider Demographics
NPI:1073539805
Name:RIVERS, CULLEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:CULLEN
Middle Name:B
Last Name:RIVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5545
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-282-1486
Practice Address - Street 1:1000 BOULDERS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5545
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027498207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006064868Medicaid
VA021784OtherCIGNA
VA188418OtherANTHEM PROVIDER NUMBER
VA31763OtherCARENET PROVIDER NUMBER
VA59274OtherSOUTHERN HEALTH PROVIDER#
VA4800158OtherUNITED HEALTH CARE PROV #
VA006895400OtherBLACK LUNG PROVIDER NUMBE
VA557515OtherAETNA PROVIDER NUMBER
VAB05785Medicare UPIN
VA59274OtherSOUTHERN HEALTH PROVIDER#
VA4800158OtherUNITED HEALTH CARE PROV #