Provider Demographics
NPI:1689683724
Name:CHICKAHOMINY FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:CHICKAHOMINY FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANUP
Authorized Official - Middle Name:
Authorized Official - Last Name:GOKLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-932-4388
Mailing Address - Street 1:P.O. BOX 278
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-3400
Mailing Address - Country:US
Mailing Address - Phone:804-932-1020
Mailing Address - Fax:804-966-9712
Practice Address - Street 1:9010 POCAHONTAS TRL
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-3400
Practice Address - Country:US
Practice Address - Phone:804-932-1020
Practice Address - Fax:804-966-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04361Medicare ID - Type Unspecified