Provider Demographics
NPI:1578616702
Name:VIRGINIA BREAST CARE, PLC
Entity Type:Organization
Organization Name:VIRGINIA BREAST CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:JOSETH
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-984-2909
Mailing Address - Street 1:595 MARTHA JEFFERSON DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4669
Mailing Address - Country:US
Mailing Address - Phone:434-984-6121
Mailing Address - Fax:434-984-3011
Practice Address - Street 1:595 MARTHA JEFFERSON DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4669
Practice Address - Country:US
Practice Address - Phone:434-984-6121
Practice Address - Fax:434-984-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08403Medicare ID - Type UnspecifiedBREAST SPECIALIST