Provider Demographics
NPI:1225329188
Name:MULTISPECIALLTY HEALTH GROUP AT SPOTSYLVANIA REGIONAL
Entity Type:Organization
Organization Name:MULTISPECIALLTY HEALTH GROUP AT SPOTSYLVANIA REGIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-423-6000
Mailing Address - Street 1:4604 SPOTSYLVANIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7763
Mailing Address - Country:US
Mailing Address - Phone:540-423-6600
Mailing Address - Fax:540-423-6655
Practice Address - Street 1:4604 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7763
Practice Address - Country:US
Practice Address - Phone:540-423-6600
Practice Address - Fax:540-423-6655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CORPORATION OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA711943133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty