Provider Demographics
NPI:1306805049
Name:TWIN RIVER MEDICAL CLINIC PC
Entity type:Organization
Organization Name:TWIN RIVER MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WK
Authorized Official - Last Name:DURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-458-8583
Mailing Address - Street 1:1012 WINSTON CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-5141
Mailing Address - Country:US
Mailing Address - Phone:804-458-8583
Mailing Address - Fax:804-541-2724
Practice Address - Street 1:1012 WINSTON CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5141
Practice Address - Country:US
Practice Address - Phone:804-458-8583
Practice Address - Fax:804-541-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACH5500OtherMEDICARE RR
VACH5500OtherMEDICARE RR