Individual
KATHERINE SUZANNE TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD,MED
Contact information
Practice address
5875 BREMO RD, SUITE 400, RICHMOND, VA 23226-1934
(804) 288-4084
(804) 282-2601
Mailing address
7130 GLEN FOREST DRIVE, SUITE 101, RICHMOND, VA 23226-3754
(804) 662-6060
(804) 282-8678
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101247079
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225246721
—
VA
Enumeration date
05/18/2007
Last updated
03/23/2011
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