Provider Demographics
NPI:1427128586
Name:CHARLOTTESVILLE FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:CHARLOTTESVILLE FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:434-973-1831
Mailing Address - Street 1:3025 BERKMAR DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1456
Mailing Address - Country:US
Mailing Address - Phone:434-973-1831
Mailing Address - Fax:434-973-1919
Practice Address - Street 1:3025 BERKMAR DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1456
Practice Address - Country:US
Practice Address - Phone:434-973-1831
Practice Address - Fax:434-973-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL4177Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
C00919Medicare ID - Type UnspecifiedGROUP NUMBER