MEDICARE: SENIORCARE GERIATRIC MEDICAL CTR LLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	0101242169	VA

General Provider Information

NPI Number	:	1770881187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIORCARE GERIATRIC MEDICAL CTR LLC

Provider Business Mailing Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 204
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-371-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 204
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-371-4488
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DANA P TATE
Credential	:
Telephone Number	:	540-371-4488

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	05/27/2011

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