Provider Demographics
NPI:1841232543
Name:CENTRAL VIRGINIA INTERNAL MEDICINE, PLC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA INTERNAL MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-656-2800
Mailing Address - Street 1:912 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5617
Mailing Address - Country:US
Mailing Address - Phone:540-656-2800
Mailing Address - Fax:540-479-6961
Practice Address - Street 1:912 LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5617
Practice Address - Country:US
Practice Address - Phone:540-656-2800
Practice Address - Fax:540-479-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08030Medicare PIN