Provider Demographics
NPI:1184786428
Name:VIRGINIA CHILD NEUROLOGY PC
Entity type:Organization
Organization Name:VIRGINIA CHILD NEUROLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-673-9600
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-673-9600
Mailing Address - Fax:804-673-8021
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 700
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-673-9600
Practice Address - Fax:804-673-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010168582080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012886OtherANTHEM
VA6131875Medicaid
B10238Medicare UPIN