Provider Demographics
NPI:1083673701
Name:RICHMOND FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:RICHMOND FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-358-0248
Mailing Address - Street 1:425 N BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3306
Mailing Address - Country:US
Mailing Address - Phone:804-358-0248
Mailing Address - Fax:804-358-9477
Practice Address - Street 1:425 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3306
Practice Address - Country:US
Practice Address - Phone:804-358-0248
Practice Address - Fax:804-358-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD1076OtherMEDICARE RAILROAD
VA005699673Medicaid
B60227Medicare UPIN
C05494Medicare PIN