Provider Demographics
NPI:1851863815
Name:VIRGINIA CANCER INSTITUTE INCORPORATED
Entity Type:Organization
Organization Name:VIRGINIA CANCER INSTITUTE INCORPORATED
Other - Org Name:VCI HARBOURSIDE CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-330-7990
Mailing Address - Street 1:7202 GLEN FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3780
Mailing Address - Country:US
Mailing Address - Phone:804-391-4171
Mailing Address - Fax:804-200-6229
Practice Address - Street 1:6130 HARBOURSIDE CENTRE LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2170
Practice Address - Country:US
Practice Address - Phone:804-378-0394
Practice Address - Fax:804-739-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty