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General NPI Number Information
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NPI Number | 1578616702
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Entity Type | Organization
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Legal Business Name | VIRGINIA BREAST CARE, PLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 595 MARTHA JEFFERSON DR SUITE 320
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4669
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Country | US
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Telephone | 434-984-6121
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Fax | 434-984-3011
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Provider Business Mailing Address
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Address Line | 595 MARTHA JEFFERSON DR SUITE 320
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4669
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Country | US
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Telephone | 434-984-6121
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Fax | 434-984-3011
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Authorized Official
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Title or Position | CFO
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Name | MRS. JASMINE JOSETH DANIEL
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Credential |
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Telephone | 434-984-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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