Provider Demographics
NPI:1326134388
Name:CHESTERFIELD FAMILY PRACTICE CENTER, PC
Entity Type:Organization
Organization Name:CHESTERFIELD FAMILY PRACTICE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-276-9305
Mailing Address - Street 1:2500 POCOSHOCK PL STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-276-9305
Mailing Address - Fax:804-674-4145
Practice Address - Street 1:2500 POCOSHOCK PL STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-276-9305
Practice Address - Fax:804-674-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1110043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACM5380OtherRAILROAD MEDICARE
VACM5380OtherRAILROAD MEDICARE