Provider Demographics
NPI:1871673160
Name:CHURCHLAND INTERNAL MEDICINE ASSOCIATES LTD
Entity Type:Organization
Organization Name:CHURCHLAND INTERNAL MEDICINE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-484-0500
Mailing Address - Street 1:2994 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5643
Mailing Address - Country:US
Mailing Address - Phone:757-484-0500
Mailing Address - Fax:757-686-2805
Practice Address - Street 1:2994 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5643
Practice Address - Country:US
Practice Address - Phone:757-484-0500
Practice Address - Fax:757-686-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138649OtherBCBS
VA190001034Medicare ID - Type Unspecified