Healthcare Provider Details

I. General information

NPI: 1366952848
Provider Name (Legal Business Name): CHARLOTTESVILLE INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
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 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 434-295-3600
  • Fax: 434-220-0121
Mailing address:
  • Phone: 540-345-3556
  • Fax: 540-777-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RASHEED SIDDIQUI
Title or Position: OWNER
Credential: MD
Phone: 434-295-3600