Provider Demographics
NPI:1639460009
Name:TOWNE MEDICAL, PC
Entity Type:Organization
Organization Name:TOWNE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUBENOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-371-4488
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-0845
Mailing Address - Country:US
Mailing Address - Phone:540-371-4488
Mailing Address - Fax:540-371-3748
Practice Address - Street 1:10514 WAKEMAN DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8040
Practice Address - Country:US
Practice Address - Phone:540-710-9340
Practice Address - Fax:540-710-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035076207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty