Provider Demographics
NPI:1205475183
Name:BADIROUS, KOUDOUS
Entity type:Individual
Prefix:
First Name:KOUDOUS
Middle Name:
Last Name:BADIROUS
Suffix:
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 1:8831 PROCTORS RUN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2774
Mailing Address - Country:US
Mailing Address - Phone:804-263-7331
Mailing Address - Fax:
Practice Address - Street 1:8831 PROCTORS RUN DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-2774
Practice Address - Country:US
Practice Address - Phone:804-263-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)