Organization
NEUROSERVICE OF VIRGINIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS RALEY M.D. (PRESIDENT)
(804) 220-4643
Entity
Organization
Contact information
Practice address
11533 BUSY ST, PMB #306, NORTH CHESTERFIELD, VA 23236-4073
(804) 220-4643
Mailing address
11533 BUSY ST, PMB #306, NORTH CHESTERFIELD, VA 23236-4073
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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