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4722 S Laburnum Ave Henrico VA 23231-2712 | |
| (804) 604-2430 | |
| (877) 471-2996 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4722 S Laburnum Ave, Henrico, Virginia |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | 4722 S Laburnum Ave Henrico VA 23231-2712 Ph: (804) 604-2430 |
| NPI Number | 1821798141 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821798141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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