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General NPI Number Information
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NPI Number | 1144390626
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 2050 HILLPOINT BLVD N
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City | SUFFOLK
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State | VA
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Zip | 23434-7181
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Country | US
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Telephone | 757-934-3434
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Fax | 757-538-9038
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Provider Business Mailing Address
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Address Line | 2050 HILLPOINT BLVD N
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City | SUFFOLK
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State | VA
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Zip | 23434-7181
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Country | US
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Telephone | 757-934-3434
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Fax | 757-538-9038
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Authorized Official
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Title or Position | ADMINSITRATOR
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Name | MARY L CARAWAN
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Credential |
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Telephone | 757-934-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101036848
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License Number State | VA
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