Provider Demographics
NPI:1780461731
Name:VIRGINIA ENDOCRINOLOGY AND OSTEOPOROSIS CENTER
Entity type:Organization
Organization Name:VIRGINIA ENDOCRINOLOGY AND OSTEOPOROSIS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-423-3636
Mailing Address - Street 1:2360 COLONY CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4280
Mailing Address - Country:US
Mailing Address - Phone:804-423-6979
Mailing Address - Fax:804-423-6985
Practice Address - Street 1:2360 COLONY CROSSING PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4280
Practice Address - Country:US
Practice Address - Phone:804-423-6979
Practice Address - Fax:804-423-6985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA ENDOCRINOLOGY AND OSTEOPOROSIS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty