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General NPI Number Information
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NPI Number | 1104845171
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Entity Type | Organization
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Legal Business Name | CHARLOTTESVILLE GYNECOLOGY SPECIALIST
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 PETER JEFFERSON PKWY STE 200
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8835
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Country | US
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Telephone | 434-296-6461
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Fax | 434-296-7529
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Provider Business Mailing Address
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Address Line | 600 PETER JEFFERSON PKWY STE 200
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8835
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Country | US
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Telephone | 434-296-6461
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Fax | 434-296-7529
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GONDE LYNN PACE
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Credential |
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Telephone | 434-296-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | VA
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