Provider Demographics
NPI:1366477234
Name:RAPPAHANNOCK NEUROSURGERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RAPPAHANNOCK NEUROSURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POFFENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-374-3200
Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-374-3200
Mailing Address - Fax:540-374-3210
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-374-3200
Practice Address - Fax:540-374-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238532207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO9653Medicare PIN