Individual
DR. JED S VANICHKACHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 MAPLE AVE, NW MOB SUITE 200, RICHMOND, VA 23226-2553
(804) 285-2300
(804) 285-8420
Mailing address
PO BOX 71690, RICHMOND, VA 23255-1690
(804) 285-2300
(804) 285-8420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101221394
VA
207X00000X
Orthopaedic Surgery Physician
0101221394
VA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
0101221394
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006409547
—
VA
01
—
173230
ANTHEM
VI
Enumeration date
05/15/2006
Last updated
08/14/2019
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