MEDICARE: LYNCHBURG INTERNAL MEDICINE INC

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	207R00000X	Internal Medicine Physician	0101021078	VA

General Provider Information

NPI Number	:	1811996572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNCHBURG INTERNAL MEDICINE INC

Provider Business Mailing Address
First Line	:	1901 THOMSON DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1008
Country	:	US
Telephone Number	:	434-947-3908
Fax Number	:	434-947-5948

Provider Business Practice Location Address
First Line	:	1901 THOMSON DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1008
Country	:	US
Telephone Number	:	434-947-3908
Fax Number	:	434-947-5948

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS CAROL P HARRIS
Credential	:
Telephone Number	:	434-947-3908

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/22/2020

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