1609930478 NPI number — VIRGINIA PAIN MANAGEMENT CONSULTANTS PC

Table of content: (NPI 1609930478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609930478 NPI number — VIRGINIA PAIN MANAGEMENT CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA PAIN MANAGEMENT CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609930478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23612-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-867-6101
Provider Business Mailing Address Fax Number:
757-867-6588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SENTARA CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-345-4400
Provider Business Practice Location Address Fax Number:
757-345-4401
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAJJAR
Authorized Official First Name:
TUSHAR
Authorized Official Middle Name:
UMAKANT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-345-4385

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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