Provider Demographics
NPI:1154832582
Name:WELLCOMEMD RICHMOND CLINIC INC
Entity Type:Organization
Organization Name:WELLCOMEMD RICHMOND CLINIC INC
Other - Org Name:VIRTUAMD CONCIERGE MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-774-7099
Mailing Address - Street 1:2500 GASKINS ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238
Mailing Address - Country:US
Mailing Address - Phone:804-774-7099
Mailing Address - Fax:804-528-5864
Practice Address - Street 1:2500 GASKINS RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1480
Practice Address - Country:US
Practice Address - Phone:804-774-7099
Practice Address - Fax:804-528-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102633207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7836242OtherAETNA
VA200044896220OtherCIGNA
VA200044896220OtherCIGNA