Organization
RIVERSIDE PHYSICIAN SERVICES INC
Active
Other names
Middle Peninsula General and Vascular Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J DOUCETTE (VICE PRESIDENT)
(757) 594-4006
Entity
Organization
Contact information
Practice address
7547 MEDICAL DRIVE, SUITE 1500, GLOUCESTER, VA 23061
(804) 693-3081
(804) 693-3283
Mailing address
856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
(757) 594-4006
(757) 594-2195
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
07/21/2006
Last updated
02/25/2008
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