Provider Demographics
NPI:1427048446
Name:LORD, ARCHIBALD L JR (MD)
Entity type:Individual
Prefix:
First Name:ARCHIBALD
Middle Name:L
Last Name:LORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 LEJACK CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1267
Mailing Address - Country:US
Mailing Address - Phone:434-942-5463
Mailing Address - Fax:
Practice Address - Street 1:1885 SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1160
Practice Address - Country:US
Practice Address - Phone:434-962-6234
Practice Address - Fax:844-297-9925
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11584207R00000X
NC2008-00696207R00000X
VA0101246662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427048446Medicaid
VA403435OtherANTHEM
VA022824M68Medicare PIN
VAD-000Medicare UPIN