Healthcare Provider Details

I. General information

NPI: 1902889363
Provider Name (Legal Business Name): PANTOPS FAMILY MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 PANTOPS MOUNTAIN PL SUITE 200
CHARLOTTESVILLE VA
22911-4601
US

IV. Provider business mailing address

PO BOX 1583
CHARLOTTESVILLE VA
22902-1583
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-4440
  • Fax: 434-979-4441
Mailing address:
  • Phone: 434-982-7794
  • Fax: 434-982-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WARREN C QUILLIAN
Title or Position: PARTNER
Credential: M.D.
Phone: 434-979-4440