Provider Demographics
NPI:1124140041
Name:KAZLAUSKAS, VYTAS (MD)
Entity type:Individual
Prefix:DR
First Name:VYTAS
Middle Name:
Last Name:KAZLAUSKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 WESTERRE PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1478
Mailing Address - Country:US
Mailing Address - Phone:804-433-1040
Mailing Address - Fax:
Practice Address - Street 1:3900 WESTERRE PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1478
Practice Address - Country:US
Practice Address - Phone:804-433-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039407208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7691084Medicaid
VAE57465Medicare UPIN
MD103R104RMedicare ID - Type Unspecified