Basic Information
| Provider Information | |||||||||
| NPI: | 1487074654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAXYMIV | ||||||||
| FirstName: | NICOLAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 E. MARSHALL ST. | ||||||||
| Address2: | BOX 980459 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408194134 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 E. MARSHALL ST. | ||||||||
| Address2: | BOX 980459 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048280733 | ||||||||
| FaxNumber: | 8048288682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2014 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 0102204260 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 0102204260 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.