Provider Demographics
NPI:1659494441
Name:WILLIAM R DANDRIDGE JR MD
Entity Type:Organization
Organization Name:WILLIAM R DANDRIDGE JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DANDRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-977-6622
Mailing Address - Street 1:1149 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-977-6622
Mailing Address - Fax:434-977-9808
Practice Address - Street 1:1149 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903
Practice Address - Country:US
Practice Address - Phone:434-977-6622
Practice Address - Fax:434-977-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACG0893OtherMEDICARE PIN
VAC06139Medicare PIN