Provider Demographics
NPI:1093774697
Name:DUNNAVANT, SIOBHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:S
Last Name:DUNNAVANT
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 1:7601 FOREST AVE
Mailing Address - Street 2:SUITE 228
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4933
Mailing Address - Country:US
Mailing Address - Phone:804-741-0440
Mailing Address - Fax:804-288-2277
Practice Address - Street 1:7601 FOREST AVE
Practice Address - Street 2:SUITE 228
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4933
Practice Address - Country:US
Practice Address - Phone:804-741-0440
Practice Address - Fax:804-288-2277
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006206069Medicaid
C06527OtherMEDICARE GROUP NUMBER
H03243Medicare UPIN
VA006206069Medicaid