Provider Demographics
NPI:1417176447
Name:FAMILY PHYSICIANS OF CHESTER PC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF CHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIZZULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-748-9071
Mailing Address - Street 1:12801 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1669
Mailing Address - Country:US
Mailing Address - Phone:804-748-9071
Mailing Address - Fax:804-768-8626
Practice Address - Street 1:12801 IRON BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-748-9071
Practice Address - Fax:804-768-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003746OtherANTHEM
VA003746OtherANTHEM