NPIMap

Organization Active NPI

Virginia Commonwealth University

  • Dental Clinic/Center
  • Richmond, VA
National Provider Identifier
1639344641
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0401008264 Issued in VA
Legal business name
VIRGINIA COMMONWEALTH UNIVERSITY
Practice address
520 N 12TH Street
Lyons BLDG Room 414
Richmond, VA 23298-0566
Phone
(804) 828-2977
Fax
(804) 828-3159
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alfred Joseph Certosimo, DMD
Title
Chair, Dept. of General Practice
Phone
(804) 828-2977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0401008264 VA Primary

Addresses

Primary practice location

520 N 12TH Street
Lyons BLDG Room 414
Richmond, VA 23298-0566

Mailing address

520 N 12TH Street
Lyons BLDG Room 414
Richmond, VA 23298-0566
Phone (804) 828-2977

Other identifiers 3

IdentifierTypeStateIssuer
153654OtherVAUNITED CONCORDIA
5894MedicaidVA
453709OtherVAANTHEM

National Provider Directory

National Provider Directory
Tax ID family
Virginia Commonwealth University9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

520 N 12th St
Rm 414
Richmond, VA 23298
Phone (804) 828-2977

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1639344641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 12TH STREET",
            "address_2": "LYONS BLDG ROOM 414",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232980566",
            "telephone_number": "804-828-2977",
            "fax_number": "804-828-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 12TH STREET",
            "address_2": "LYONS BLDG ROOM 414",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232980566",
            "telephone_number": "804-828-2977",
            "fax_number": "804-828-3159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA COMMONWEALTH UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "CERTOSIMO",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CHAIR, DEPT. OF GENERAL PRACTICE",
        "authorized_official_telephone_number": "804-828-2977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401008264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "153654",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5894",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "453709",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.