Provider Demographics
NPI:1154624211
Name:MARYVIEW HOSPITAL
Entity type:Organization
Organization Name:MARYVIEW HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRICONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-8301
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:4053 TAYLOR RD STE N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5526
Practice Address - Country:US
Practice Address - Phone:757-484-5900
Practice Address - Fax:757-483-6671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10680Medicare PIN
VADP0013Medicare PIN