Waller, Richard Edmund

Waller, Richard Edmund is an individual health care provider with primary practice located at 14355 Sommerville Ct , Midlothian VA 23113. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Waller, Richard Edmund can be contacted via phone (804) 379-7721.

Contact Information

Primary practice address
14355 Sommerville Ct Midlothian VA 23113
Phone: (804) 379-7721
Fax: (804) 379-7699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0101040746 Virginia
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 0101040746 Virginia

Profile Details

NPI number 1871541862
LBN Legal business name Waller, Richard Edmund
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Mar 24th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871541862 NPPES
Virginia MEDICAID 010131855

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