Healthcare Provider Details

I. General information

NPI: 1811923410
Provider Name (Legal Business Name): CHARLOTTESVILLE PAIN MANAGEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 ABBEY RD STE A
CHARLOTTESVILLE VA
22911-3553
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 434-295-3600
  • Fax: 434-220-0121
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LANDER
Title or Position: PARTNER
Credential: MD
Phone: 434-295-3600