Healthcare Provider Details

I. General information

NPI: 1629835244
Provider Name (Legal Business Name): VON ELTEN FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DOGWOOD LN
ORANGE VA
22960-1058
US

IV. Provider business mailing address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

V. Phone/Fax

Practice location:
  • Phone: 540-672-2611
  • Fax: 540-672-2611
Mailing address:
  • Phone: 434-770-1000
  • Fax: 804-282-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER B VON ELTEN
Title or Position: SOLE MEMBER
Credential: MD
Phone: 434-770-1000