Provider Demographics
NPI:1033151733
Name:CENTRAL VIRGINIA OB-GYN GROUP, PC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA OB-GYN GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-373-4900
Mailing Address - Street 1:1011 CARE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-373-4900
Mailing Address - Fax:540-373-5195
Practice Address - Street 1:1011 CARE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-373-4900
Practice Address - Fax:540-373-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02529Medicare PIN