Provider Demographics
NPI:1235763673
Name:VIRTUAL CONSULT MD LLC
Entity Type:Organization
Organization Name:VIRTUAL CONSULT MD LLC
Other - Org Name:VIRTUAL CONSULT MD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-200-0048
Mailing Address - Street 1:1222 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8002
Mailing Address - Country:US
Mailing Address - Phone:812-720-3800
Mailing Address - Fax:812-727-5469
Practice Address - Street 1:46 TECHNOLOGY PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2906
Practice Address - Country:US
Practice Address - Phone:812-720-3800
Practice Address - Fax:812-727-5469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUAL CONSULT MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty