Provider Demographics
NPI:1164429189
Name:FAMILY MEDICINE OF ALBEMARLE, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF ALBEMARLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-973-9744
Mailing Address - Street 1:1450 SACHEM PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2554
Mailing Address - Country:US
Mailing Address - Phone:434-973-9744
Mailing Address - Fax:434-973-9790
Practice Address - Street 1:1450 SACHEM PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2554
Practice Address - Country:US
Practice Address - Phone:434-973-9744
Practice Address - Fax:434-973-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004580OtherANTHEM BLUE CROSS BLUE SH
VA132097OtherCOVENTRY/SOUTHERN HEALTH
VA004580OtherANTHEM BLUE CROSS BLUE SH