Provider Demographics
NPI:1922075621
Name:PIEDMONT INTERNAL MEDICINE PLC
Entity Type:Organization
Organization Name:PIEDMONT INTERNAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:QUESENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-341-7521
Mailing Address - Street 1:419 HOLIDAY COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-4200
Mailing Address - Fax:540-341-7521
Practice Address - Street 1:419 HOLIDAY COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-4200
Practice Address - Fax:540-341-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08879Medicare ID - Type Unspecified