MEDICARE: HALIFAXMED, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		VA

General Provider Information

NPI Number	:	1174551725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALIFAXMED, PLC

Provider Business Mailing Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3428
Country	:	US
Telephone Number	:	434-572-1171
Fax Number	:	434-572-1776

Provider Business Practice Location Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3428
Country	:	US
Telephone Number	:	434-572-9355
Fax Number	:	434-572-4818

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES H. PARKER JR.
Credential	:	M.D.
Telephone Number	:	434-572-1171

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/14/2010

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