Healthcare Provider Details

I. General information

NPI: 1871673160
Provider Name (Legal Business Name): CHURCHLAND INTERNAL MEDICINE ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2994 CHURCHLAND BLVD
CHESAPEAKE VA
23321-5643
US

IV. Provider business mailing address

2994 CHURCHLAND BLVD
CHESAPEAKE VA
23321-5643
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-0500
  • Fax: 757-686-8156
Mailing address:
  • Phone: 757-484-0500
  • Fax: 757-686-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A HARRINGTON JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-484-0500