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General NPI Number Information
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NPI Number | 1588722425
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Entity Type | Organization
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Legal Business Name | LAKE MANASSAS MEDICAL PSYCHIATRY
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7544 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 703-772-7400
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Fax | 703-940-9179
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Provider Business Mailing Address
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Address Line | 7544 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 703-772-7400
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Fax | 703-940-9179
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. CRAIG CHARLES KRAUSE
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Credential | MD
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Telephone | 703-772-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101233772
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License Number State | VA
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