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General NPI Number Information
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NPI Number | 1174551725
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Entity Type | Organization
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Legal Business Name | HALIFAXMED, PLC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1627 SEYMOUR DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-3428
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Country | US
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Telephone | 434-572-9355
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Fax | 434-572-4818
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Provider Business Mailing Address
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Address Line | 1627 SEYMOUR DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-3428
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Country | US
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Telephone | 434-572-1171
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Fax | 434-572-1776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES H. PARKER JR.
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Credential | M.D.
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Telephone | 434-572-1171
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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 |
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License Number State | VA
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