Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
Jun 26, 2008
License(s)
01069935A (IN), 46161 (KY), 46161 (KY), 0101287896 (VA), 46161 (KY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 780125 | Philadelphia, PA 19178-0125 | 804-922-4844 |
| LOCATION | 1250 E MARSHALL ST | Richmond, VA 23298-5023 | 804-828-2207 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.