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13609 Carrollton Blvd Ste 11 Carrollton VA 23314-3214 | |
(757) 238-8751 | |
(757) 238-8750 |
Full Name | |
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Speciality | Family Medicine |
Location | 13609 Carrollton Blvd Ste 11, Carrollton, Virginia |
Authorized Official Name and Position | Stephan Quiriconi (CFO) |
Authorized Official Contact | 8042818301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8580 Magellan Pkwy Richmond VA 23227-1149 Ph: (804) 627-5462 | 13609 Carrollton Blvd Ste 11 Carrollton VA 23314-3214 Ph: (757) 238-8751 |
NPI Number | 1316193741 |
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Provider Enumeration Date | 08/18/2008 |
Last Update Date | 05/29/2019 |
Identifier | Type | State | Issuer |
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1316193741 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |