Provider Demographics
NPI:1124062468
Name:VA INSTITUTE OF NEUROPSYCHIATRY, INC.
Entity type:Organization
Organization Name:VA INSTITUTE OF NEUROPSYCHIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-594-7046
Mailing Address - Street 1:2621 PROMENADE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1431
Mailing Address - Country:US
Mailing Address - Phone:804-594-7046
Mailing Address - Fax:804-594-2635
Practice Address - Street 1:2621 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1431
Practice Address - Country:US
Practice Address - Phone:804-594-7046
Practice Address - Fax:804-594-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA173345OtherANTHEM BLUE SHIELD
VAC09265Medicare ID - Type Unspecified