Provider Demographics
NPI:1750474797
Name:DOMINION PRIMARY CARE PC
Entity Type:Organization
Organization Name:DOMINION PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-791-1562
Mailing Address - Street 1:110 EXCHANGE ST STE F
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3500
Mailing Address - Country:US
Mailing Address - Phone:434-791-1562
Mailing Address - Fax:434-791-3776
Practice Address - Street 1:110 EXCHANGE ST STE F
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-3500
Practice Address - Country:US
Practice Address - Phone:434-791-1562
Practice Address - Fax:434-791-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275536567Medicare UPIN
VA1437152865Medicare UPIN
VA1568465854Medicare UPIN