Individual
DR. WARREN KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 GLENSIDE DR STE 110, RICHMOND, VA 23226-3769
(804) 288-1800
(804) 288-0515
Mailing address
1800 GLENSIDE DR, SUITE 105, RICHMOND, VA 23226-3769
(804) 288-0399
(804) 285-0088
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101048298
VA
207Q00000X
Family Medicine Physician
Primary
0101048298
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006011586
—
VA
05
—
1023090289
—
VA
01
—
110089873
MEDICARE RAILROAD
VA
01
—
141499
ANTHEM
VA
Enumeration date
11/15/2005
Last updated
01/03/2012
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