Provider Demographics
NPI:1497765226
Name:OSTEOPATHIC PHYSICIANS OF CHARLOTTESVILLE
Entity Type:Organization
Organization Name:OSTEOPATHIC PHYSICIANS OF CHARLOTTESVILLE
Other - Org Name:OSTEOPATHIC PAIN MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:434-975-2555
Mailing Address - Street 1:630 PETER JEFFERSON PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8605
Mailing Address - Country:US
Mailing Address - Phone:434-975-2555
Mailing Address - Fax:434-974-6900
Practice Address - Street 1:630 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8605
Practice Address - Country:US
Practice Address - Phone:434-975-2555
Practice Address - Fax:434-974-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177604OtherANTHEM
VAC09706Medicare ID - Type Unspecified