Provider Demographics
NPI:1578870150
Name:VANDESSEL, HENDRIKUS J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENDRIKUS
Middle Name:J
Last Name:VANDESSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HAXALL PT
Mailing Address - Street 2:# 702
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3941
Mailing Address - Country:US
Mailing Address - Phone:804-928-6416
Mailing Address - Fax:
Practice Address - Street 1:1101 HAXALL PT
Practice Address - Street 2:# 702
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3941
Practice Address - Country:US
Practice Address - Phone:804-928-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0109542068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist