Healthcare Provider Details

I. General information

NPI: 1720618184
Provider Name (Legal Business Name): EGBERT CHARLES MCFARLANE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E NINE MILE RD
HENRICO VA
23075-2306
US

IV. Provider business mailing address

6712 GILLS GATE TER
CHESTERFIELD VA
23832-6001
US

V. Phone/Fax

Practice location:
  • Phone: 804-252-9429
  • Fax:
Mailing address:
  • Phone: 804-252-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: