Provider Demographics
NPI:1457741126
Name:NMG AFFILIATE PRACTICE I LLC
Entity Type:Organization
Organization Name:NMG AFFILIATE PRACTICE I LLC
Other - Org Name:NOVANT HEALTH UVA HEALTH SYSTEM VIRGINIA INTERNAL MEDICINE & PRIMARY C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-328-6332
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:
Practice Address - Street 1:8575 SUDLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3861
Practice Address - Country:US
Practice Address - Phone:703-361-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty