Provider Demographics
NPI:1922169333
Name:FLUVANNA FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:FLUVANNA FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:GENERELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-591-1314
Mailing Address - Street 1:5766 THOMAS JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-4383
Mailing Address - Country:US
Mailing Address - Phone:434-591-1314
Mailing Address - Fax:434-591-1317
Practice Address - Street 1:5766 THOMAS JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-4383
Practice Address - Country:US
Practice Address - Phone:434-591-1314
Practice Address - Fax:434-591-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE37741Medicare UPIN