Provider Demographics
NPI:1083704639
Name:STRAVITZ, RICHARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:STRAVITZ
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:PO BOX 980341
Mailing Address - Street 2:MCV-VCU
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0341
Mailing Address - Country:US
Mailing Address - Phone:804-828-4060
Mailing Address - Fax:804-828-4945
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:828-406-0804
Practice Address - Fax:828-494-5804
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045478207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005849497Medicaid
E01438Medicare UPIN
100000271Medicare ID - Type Unspecified