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General NPI Number Information
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NPI Number | 1497282503
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Entity Type | Organization
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Legal Business Name | DOMINION FAMILY CARE, LLC
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4101 DOMINION BLVD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3457
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Country | US
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Telephone | 804-747-5555
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Fax | 804-747-5550
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Provider Business Mailing Address
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Address Line | 4101 DOMINION BLVD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3457
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Country | US
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Telephone | 804-747-5555
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Fax | 804-747-5550
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANDREA L HALL
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Credential | MD
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Telephone | 804-747-5555
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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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