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General NPI Number Information
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NPI Number | 1740450584
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Entity Type | Organization
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Legal Business Name | VICTORIA FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 3212B HAMPTON HWY
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City | YORKTOWN
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State | VA
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Zip | 23693-4904
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Country | US
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Telephone | 757-867-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 3212B HAMPTON HWY
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City | YORKTOWN
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State | VA
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Zip | 23693-4904
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Country | US
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Telephone | 757-867-6160
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. TIMOTHY LEE RAINES
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Credential |
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Telephone | 757-867-6160
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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 | 0101046857
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License Number State | VA
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