Provider Demographics
NPI: | 1710959457 |
---|---|
Name: | MCV ASSOCIATED PHYSICIANS |
Entity Type: | Organization |
Organization Name: | MCV ASSOCIATED PHYSICIANS |
Other - Org Name: | MCV PHYSICIANS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER, PROVIDER ENROLLMENT OFFICE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHARLYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HANDY-AKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 804-828-8647 |
Mailing Address - Street 1: | PO BOX 780125 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19178-0125 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-922-4844 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1250 E MARSHALL ST |
Practice Address - Street 2: | MAIN 1-214, BOX 980510 |
Practice Address - City: | RICHMOND |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23298-5051 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-828-8707 |
Practice Address - Fax: | 804-828-8765 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-02-06 |
Last Update Date: | 2023-03-15 |
Deactivation Date: | 2006-07-17 |
Deactivation Code: | |
Reactivation Date: | 2006-08-15 |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 207L00000X | |
207N00000X, 207P00000X, 207Q00000X, 207T00000X, 207V00000X, 207W00000X, 207X00000X, 207Y00000X, 207ZP0102X, 208000000X, 2084N0400X, 2084P0800X, 2085R0001X, 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | C03683 | Medicare PIN | |
VA | C04383 | Medicare PIN | |
VA | C03041 | Medicare PIN | |
VA | C03684 | Medicare PIN | |
VA | C03687 | Medicare PIN | |
VA | C03691 | Medicare PIN | |
VA | C03695 | Medicare PIN | |
VA | C03042 | Medicare PIN | |
VA | C03693 | Medicare PIN | |
VA | C01506 | Medicare PIN | |
VA | C03690 | Medicare PIN | |
VA | C03698 | Medicare PIN | |
VA | C05015 | Medicare PIN | |
VA | C03682 | Medicare PIN | |
VA | C03694 | Medicare PIN | |
VA | C03683 | Medicare ID - Type Unspecified | FAMILY MEDICINE |
VA | C03698 | Medicare PIN | |
VA | C03695 | Medicare PIN | |
VA | C03691 | Medicare PIN | |
VA | C03042 | Medicare ID - Type Unspecified | ANESTHESIOLOGY |
VA | C04383 | Medicare PIN | |
VA | C03682 | Medicare PIN | |
VA | C03686 | Medicare ID - Type Unspecified | OB GYN |
VA | C03690 | Medicare ID - Type Unspecified | ORTHOPAEDIC SURGERY |
VA | C03683 | Medicare PIN | |
VA | C03685 | Medicare ID - Type Unspecified | NEUROLOGY |
VA | C03693 | Medicare ID - Type Unspecified | PEDIATRICS |
VA | C05015 | Medicare PIN | |
VA | C03694 | Medicare PIN | |
VA | C03687 | Medicare PIN | |
VA | C03042 | Medicare PIN | |
VA | C01506 | Medicare PIN |