Healthcare Provider Details

I. General information

NPI: 1356361398
Provider Name (Legal Business Name): GOOCHLAND FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 RIVER ROAD WEST
GOOCHLAND VA
23063-0669
US

IV. Provider business mailing address

PO BOX 669
GOOCHLAND VA
23063-0669
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-6101
  • Fax: 804-556-6468
Mailing address:
  • Phone: 804-556-6101
  • Fax: 804-556-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101029901
License Number StateVA

VIII. Authorized Official

Name: DR. FRANK BAIN
Title or Position: LEAD PHYSICIAN
Credential: MD
Phone: 804-556-6101