Organization
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Active
Other names
Glen Allen Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE O BUTLER (DIRECTOR CORPORATE RESPONSIBILITY)
(804) 281-0271
Entity
Organization
Contact information
Practice address
5207 HICKORY PARK DR, SUITE A, GLEN ALLEN, VA 23059-2624
(804) 612-2980
(804) 762-7102
Mailing address
5207 HICKORY PARK DR, SUITE A, GLEN ALLEN, VA 23059-2624
(804) 612-2980
(804) 762-7102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
11/15/2011
Last updated
10/24/2018
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