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NPI Code Detail

MEDICARE: ALTIUS FAMILY AND SPORTS MEDICINE, PLC

MEDICARE: ALTIUS FAMILY AND SPORTS MEDICINE, 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1437410OTHERAETNA

General Provider Information

NPI Number : 1093772766
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTIUS FAMILY AND SPORTS MEDICINE, PLC
Provider Business Mailing Address
First Line : 2530 GASKINS RD
Second Line : SUITE A
City : RICHMOND
State : VA
Zip : 23238-1483
Country : US
Telephone Number : 804-290-0593
Fax Number : 804-290-0594
Provider Business Practice Location Address
First Line : 2530 GASKINS RD
Second Line : SUITE A
City : RICHMOND
State : VA
Zip : 23238-1483
Country : US
Telephone Number : 804-290-0593
Fax Number : 804-290-0594
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : DR. MATTHEW WALTER MARCHAL
Credential : M.D.
Telephone Number : 804-290-0593
Provider Enumeration Date : 04/27/2006
Last Update Date : 04/20/2008

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Directions to “ALTIUS FAMILY AND SPORTS MEDICINE, PLC ” Practice Location

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