Provider Demographics
NPI:1518527456
Name:BYRD, CARL A JR
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:BYRD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7701
Mailing Address - Country:US
Mailing Address - Phone:804-928-9487
Mailing Address - Fax:
Practice Address - Street 1:1001 N 35TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7701
Practice Address - Country:US
Practice Address - Phone:804-928-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT62924275172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver