Provider Demographics
NPI:1164208344
Name:VIRGINIA CHILD NEUROLOGY SPECIALISTS, PC
Entity Type:Organization
Organization Name:VIRGINIA CHILD NEUROLOGY SPECIALISTS, PC
Other - Org Name:VIRGINIA CHILD NEUROLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:804-322-7800
Mailing Address - Street 1:5102 W VILLAGE GREEN DR STE 109
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4876
Mailing Address - Country:US
Mailing Address - Phone:804-322-7800
Mailing Address - Fax:833-637-1610
Practice Address - Street 1:5102 W VILLAGE GREEN DR STE 109
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4876
Practice Address - Country:US
Practice Address - Phone:804-322-7800
Practice Address - Fax:866-493-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015462790002Medicaid