Provider Demographics
NPI:1316944531
Name:BOATWRIGHT, JOSEPH WELDON III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WELDON
Last Name:BOATWRIGHT
Suffix:III
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:PO BOX 26591
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23261-6591
Mailing Address - Country:US
Mailing Address - Phone:804-643-8914
Mailing Address - Fax:804-643-4237
Practice Address - Street 1:211 E CLAY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1325
Practice Address - Country:US
Practice Address - Phone:804-643-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6775365Medicaid
VAF78079Medicare ID - Type Unspecified
VAF78089Medicare UPIN