Individual
RUSSELL W. LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
417 N 11TH ST, RICHMOND, VA 23298
(804) 828-4097
(804) 828-5533
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101264123
VA
Other
Enumeration date
04/15/2014
Last updated
08/14/2018
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