MEDICARE: CHESTER SQUARE FAMILY PRACTICE, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101052854	VA

General Provider Information

NPI Number	:	1023292885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTER SQUARE FAMILY PRACTICE, PLC

Provider Business Mailing Address
First Line	:	4619 CHESTER SQUARE ROAD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1726
Country	:	US
Telephone Number	:	804-778-4747
Fax Number	:	804-778-4487

Provider Business Practice Location Address
First Line	:	4619 CHESTER SQUARE ROAD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1726
Country	:	US
Telephone Number	:	804-778-4747
Fax Number	:	804-778-4487

Authorized Official
Title or Position	:	M.D./BUSINESS OWNER
Name	:	DR. BRIAN GRIEG BURIJON
Credential	:	M.D.
Telephone Number	:	804-778-4747

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	10/22/2008

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