MEDICARE: CARY STREET FAMILY PRACTICE

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

General Provider Information

NPI Number	:	1396968392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARY STREET FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	4906 CUTSHAW AVE
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-353-0010
Fax Number	:	804-278-8796

Provider Business Practice Location Address
First Line	:	4906 CUTSHAW AVE
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-353-0010
Fax Number	:	804-278-8796

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	MS. BEVERLY BROOKS DEATS
Credential	:
Telephone Number	:	804-353-0010

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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Directions to “CARY STREET FAMILY PRACTICE ” Practice Location

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