Organization
VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM
Active
Other names
Medicaid - Nurse Practitioners
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC J PULEO (CFO)
(804) 828-1295
Entity
Organization
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-5051
(804) 828-6315
Mailing address
PO BOX 758997, BALTIMORE, MD 21275-0001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
H1875
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7790554
—
VA
Enumeration date
01/05/2007
Last updated
08/22/2020
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