Provider Demographics
NPI:1881675494
Name:BOURHILL, ERIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:BOURHILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 DUGSPUR RD
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-3009
Mailing Address - Country:US
Mailing Address - Phone:540-483-5876
Mailing Address - Fax:
Practice Address - Street 1:6675 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:WIRTZ
Practice Address - State:VA
Practice Address - Zip Code:24184-4128
Practice Address - Country:US
Practice Address - Phone:540-721-2118
Practice Address - Fax:540-721-6448
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-042471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5623707Medicaid
VA017881C18Medicare PIN
C82343Medicare UPIN
080005671Medicare PIN