Organization
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Active
Other names
Bon Secours Surgical Dermatology Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN QUIRICONI (CFO)
(804) 281-8301
Entity
Organization
Contact information
Practice address
5207 HICKORY PARK DR, SUITE A, GLEN ALLEN, VA 23059-2624
(804) 977-8938
(804) 762-7102
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
03/22/2011
Last updated
08/30/2019
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