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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | GROUP PTAN | C06778 | 01 |
| Other Name | Type Code |
|---|---|
| Bon Secours Surgical Dermatology Center | Doing Business As Name - Organization |
| 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 |
| Street Address |
5207 HICKORY PARK DR SUITE A |
| City | GLEN ALLEN |
| State | VA |
| Zip Code | 23059-2624 |
| 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 | ||||
| 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 Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| 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. |
| 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 | ||||
| City | GLEN ALLEN |
| Zip Code | 23059 |
Please comment or provide details below to improve the information on BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC..
| 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.