Healthcare Provider Details

I. General information

NPI: 1346278611
Provider Name (Legal Business Name): GEORGE P. DAMEWOOD IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GLOUCESTER RD
STUARTS DRAFT VA
24477-3321
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 540-337-3710
  • Fax: 540-337-0930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101049537
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: