Healthcare Provider Details

I. General information

NPI: 1366477234
Provider Name (Legal Business Name): RAPPAHANNOCK NEUROSURGERY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 207
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

1101 SAM PERRY BLVD SUITE 207
FREDERICKSBURG VA
22401-4467
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3200
  • Fax: 540-374-3210
Mailing address:
  • Phone: 540-374-3200
  • Fax: 540-374-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101238532
License Number StateVA

VIII. Authorized Official

Name: GLEN J. POFFENBARGER
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 540-374-3200