Provider Demographics
NPI:1720168032
Name:CHARLES H PARKER JR MD PC
Entity Type:Organization
Organization Name:CHARLES H PARKER JR MD PC
Other - Org Name:HALIFAX GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-476-1220
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0397
Mailing Address - Country:US
Mailing Address - Phone:434-476-1220
Mailing Address - Fax:434-476-1440
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-3211
Practice Address - Country:US
Practice Address - Phone:434-476-1220
Practice Address - Fax:434-476-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041330207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08358Medicare ID - Type UnspecifiedPROVIDER NUMBER