Healthcare Provider Details

I. General information

NPI: 1689683724
Provider Name (Legal Business Name): CHICKAHOMINY FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 POCAHONTAS TRL
PROVIDENCE FORGE VA
23140-3400
US

IV. Provider business mailing address

P.O. BOX 278
PROVIDENCE FORGE VA
23140-3400
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-1020
  • Fax: 804-966-9712
Mailing address:
  • Phone: 804-932-1020
  • Fax: 804-966-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANUP GOKLI
Title or Position: PHYSICIAN/PARTNER
Credential: MD
Phone: 804-932-4388