Individual
BAO VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1215 LEE ST, BOX 801210, CHARLOTTESVILLE, VA 22908-0816
(434) 924-5314
(433) 243-4743
Mailing address
1215 LEE ST, BOX 801210, CHARLOTTESVILLE, VA 22908-0816
(434) 924-5314
(433) 243-4743
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0102205669
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2015
Last updated
06/09/2020
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