Individual
DR. RODERICK ERVIN HAITHCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 W. LEIGH STREET, SUITE 303, RICHMOND, VA 23220
(804) 644-1333
(804) 782-1193
Mailing address
505 W. LEIGH STREET, SUITE 303, RICHMOND, VA 23220
(804) 644-1333
(804) 782-1193
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101029287
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6078460
—
VA
01
—
C06695
GROUP PTAN
VA
Enumeration date
10/07/2005
Last updated
11/21/2024
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