Healthcare Provider Details

I. General information

NPI: 1043252802
Provider Name (Legal Business Name): KING GEORGE MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16463 DAHLGREN RD
DAHLGREN VA
22448
US

IV. Provider business mailing address

PO BOX 845
FREDERICKSBURG VA
22404-0845
US

V. Phone/Fax

Practice location:
  • Phone: 540-663-2188
  • Fax:
Mailing address:
  • Phone: 540-371-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY H. SCHWARTZ
Title or Position: SECRETARY TREASURER
Credential:
Phone: 540-371-4488