Healthcare Provider Details

I. General information

NPI: 1972530210
Provider Name (Legal Business Name): PL PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EMPIRE CT.
FREDERICKSBURG VA
22408-1939
US

IV. Provider business mailing address

4550 EMPIRE CT.
FREDERICKSBURG VA
22408-1939
US

V. Phone/Fax

Practice location:
  • Phone: 540-361-1800
  • Fax: 540-361-1103
Mailing address:
  • Phone: 540-361-1800
  • Fax: 540-361-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237959
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241779
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043865
License Number StateVA

VIII. Authorized Official

Name: MR. DANA P. TATE
Title or Position: VICE PRESIDENT
Credential:
Phone: 540-371-4488