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General NPI Number Information
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NPI Number | 1467532218
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Entity Type | Organization
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Legal Business Name | CENTREVILLE FAMILY PRACTICE
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13890 BRADDOCK RD SUITE 201
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City | CENTREVILLE
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State | VA
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Zip | 20121-2435
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Country | US
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Telephone | 703-631-0331
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Fax | 703-631-2573
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Provider Business Mailing Address
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Address Line | 13890 BRADDOCK RD SUITE 201
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City | CENTREVILLE
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State | VA
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Zip | 20121-2435
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Country | US
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Telephone | 703-631-0331
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Fax | 703-631-2573
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD BOXLEY BOWLES
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Credential | M.D.
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Telephone | 703-631-0331
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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 |
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