BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.


Address: 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624
Phone: 8049778938

BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC. (NPI# 1629377221) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1629377221
Entity Type Organization
Organization Name BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Other Organization Name BON SECOURS SURGICAL DERMATOLOGY CENTER
Practice Address 5207 Hickory Park Dr
Suite A
Glen Allen
VA 23059-2624
Mailing Address 8580 Magellan Pkwy
Richmond
VA 23227-1149
Practice Telephone 8049778938
Practice Fax Number 8047627102
Mailing Fax Number 8664490896
Enumeration Date 2011-03-22
Last Update Date 2019-08-30
Authorized Official Name STEPHAN QUIRICONI (CFO)
Authorized Official Telephone 8042818301
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
VA GROUP PTAN C06778 01

Other Provider/Organization Names

Other Name Type Code
Bon Secours Surgical Dermatology Center Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1194360503 Bon Secours-st. Mary's Hospital of Richmond, Inc. Internal Medicine 5899 Bremo Rd Ste 202, Richmond, VA 23226-1935 2019-11-08
1346741667 Bon Secours-st. Mary's Hospital of Richmond, Inc. Clinic/Center 12320 W Broad St Ste 100, Richmond, VA 23233 2018-02-22
1215438544 Bon Secours-st. Mary's Hospital of Richmond, Inc. Clinic/Center 12320 W Broad St Ste 100a, Richmond, VA 23233 2018-02-22
1508388554 Bon Secours-st. Mary's Hospital of Richmond, Inc. Surgery 5875 Bremo Rd Ste 110, Richmond, VA 23226-1934 2017-07-12
1255776290 Bon Secours-st. Mary's Hospital of Richmond, Inc. Internal Medicine 2401 W Leigh Street, Richmond, VA 23220-1328 2013-05-03
1639430093 Bon Secours-st. Mary's Hospital of Richmond, Inc. Psychologist 5855 Bremo Rd Ste 404, Mob North, Richmond, VA 23226-1924 2012-06-01
1548529126 Bon Secours-st. Mary's Hospital of Richmond, Inc. Pediatrics 5855 Bremo Rd Ste 605, Richmond, VA 23226-1926 2012-05-16
1508125386 Bon Secours-st. Mary's Hospital of Richmond, Inc. Internal Medicine 1501 Maple Ave Ste 100, Richmond, VA 23226-2553 2012-05-14
1013280544 Bon Secours-st. Mary's Hospital of Richmond, Inc. Internal Medicine 5875 Bremo Rd Ste G11, Mob South, Richmond, VA 23226-1934 2012-02-14
1265736680 Bon Secours-st. Mary's Hospital of Richmond, Inc. Pediatrics 5855 Bremo Rd Ste 703, Richmond, VA 23226-1926 2010-12-28

Office Location

Street Address 5207 HICKORY PARK DR
SUITE A
City GLEN ALLEN
State VA
Zip Code 23059-2624

Providers in the same location

NPI Name Taxonomy Address Enumeration
1477543387 Shelley B. Woodley Nurse Practitioner 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2005-10-24
1568899409 Bon Secours Virginia Medical Group I, LLC Dermatology 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2013-10-10
1518301050 Jason Anthony Leone Nurse Practitioner 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2013-04-27
1063799302 Bon Secours-st. Mary's Hospital of Richmond, Inc. Internal Medicine 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2011-11-15
1275829673 Allison B Trevillian Nurse Practitioner 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2011-06-23
1811294614 Shannon Jeanette Cannon Registered Nurse 5207 Hickory Park Dr, Suite C, Glen Allen, VA 23059-2624 2011-02-15
1972783918 Bon Secours-virginia Healthsource Internal Medicine 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059 2007-11-07
1407053713 Aysha Habib Internal Medicine 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2007-06-29
1720157357 Julia K. Padgett Dermatology 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2006-11-07
1699731554 Jill Elaine Ryland Pediatrics 5207 Hickory Park Dr, Suite C, Glen Allen, VA 23059-2624 2006-04-20
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1003422163 Kusum Bhetwal Nurse Practitioner 12804 Westin Estates Drive, Glen Allen, VA 23059 2020-09-23
1538704770 Rise Services LLC Community/Behavioral Health 11357 Nuckois Road, Suite 2043, Glen Allen, VA 23059 2019-11-12
1992347116 Irene Anne Mcgovern Technician 5233 Eastbranch Dr, Glen Allen, VA 23059 2019-10-09
1427547322 Sharon Ann Lott Audiologist Short Pump Middle School, 4701 Pouncey Tract Road, Glen Allen, VA 23059 2018-05-07
1518476423 Thomas Joseph Stein Pharmacist 4912 Old Millrace Place, Glen Allen, VA 23059 2017-09-22
1033638440 Caroline Taylor Specialist/Technologist 5143 Dorin Hill Ct., Glen Allen, VA 23059 2017-09-18
1003335167 Rva Transport, Inc. Non-emergency Medical Transport (VAN) 830 Brassie Ln, Apt F, Glen Allen, VA 23059 2017-09-10
1639628407 Jessica Jasmine Green Nurse Practitioner 4687 Poucey Tract Road, Glen Allen, VA 23059 2016-09-22
1255512760 Peggy Ellen York Psychologist 13314 Greenwood Rd, Glen Allen, VA 23059 2007-11-27
1689795940 Kim Blassic Dentist 5225 Hickory Park Dr., Suite D, Glen Allen, VA 23059 2007-04-03
Find all providers in zip 23059

Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1356821235 Sdm Virginia LLC Dermatology 4198 Cox Rd Ste 109, Glen Allen, VA 23060-3328 2018-08-20
1932460441 William Spencer Gillen Dermatology 5207 Hickory Park Dr Ste A, Glen Allen, VA 23059-2624 2012-05-31
1316952716 Dermatology Associates of Richmond PC Dermatology 201 Concourse Blvd Ste 110, Glen Allen, VA 23059 2006-07-31
1972581007 Erin Gilbert Adams Dermatology 5201 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2623 2006-01-09
1912907650 Suzanne Granados Spadafora Dermatology 301 Concourse Blvd, Suite 190, Glen Allen, VA 23059-5643 2005-07-22
1568899409 Bon Secours Virginia Medical Group I, LLC Dermatology 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2013-10-10
1659632057 Patricia W O'connor Dermatology 201 Concourse Blvd Ste 110, Glen Allen, VA 23059-5640 2012-06-01
1629230040 Raj Agarwal Dermatology 201 Concourse Blvd Ste 110, Glen Allen, VA 23059-5640 2008-06-26
1366642852 Dominion Dermatology PC Dermatology 5201 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2623 2007-07-23
1720157357 Julia K. Padgett Dermatology 5207 Hickory Park Dr, Suite A, Glen Allen, VA 23059-2624 2006-11-07
Find all providers in GLEN ALLEN

Competitor

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City GLEN ALLEN
Zip Code 23059

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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