Provider Demographics
NPI:1477956878
Name:VIRGINIA COMMONWEALTH UNIVERSITY
Entity Type:Organization
Organization Name:VIRGINIA COMMONWEALTH UNIVERSITY
Other - Org Name:VA COMMONWEALTH UNIVERSITY SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-828-0100
Mailing Address - Street 1:821 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284-9012
Mailing Address - Country:US
Mailing Address - Phone:804-828-0100
Mailing Address - Fax:
Practice Address - Street 1:821 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-9012
Practice Address - Country:US
Practice Address - Phone:804-828-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty