Provider Demographics
NPI:1124269238
Name:PRIMECARE INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:PRIMECARE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARFIELD
Authorized Official - Middle Name:HUE
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-518-8827
Mailing Address - Street 1:4460 CORPORATION LN
Mailing Address - Street 2:CORPORATION CENTER ONE, SUITE 190
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3150
Mailing Address - Country:US
Mailing Address - Phone:757-518-8827
Mailing Address - Fax:
Practice Address - Street 1:4460 CORPORATION LN
Practice Address - Street 2:CORPORATION CENTER ONE, SUITE 190
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3150
Practice Address - Country:US
Practice Address - Phone:757-518-8827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty