Provider Demographics
NPI:1457560997
Name:RHEUMATOLOGY ASSOCIATES OF CENTRAL VIRGINIA LLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES OF CENTRAL VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1411
Mailing Address - Street 1:2216 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3300
Mailing Address - Country:US
Mailing Address - Phone:540-899-1354
Mailing Address - Fax:540-899-3599
Practice Address - Street 1:2216 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3300
Practice Address - Country:US
Practice Address - Phone:540-899-1354
Practice Address - Fax:540-899-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10349Medicare PIN