Provider Demographics
NPI:1720479504
Name:AFFINITY HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:AFFINITY HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-673-3644
Mailing Address - Street 1:3356 WESTERN BRANCH BLVD
Mailing Address - Street 2:#F
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5138
Mailing Address - Country:US
Mailing Address - Phone:757-673-3644
Mailing Address - Fax:757-337-0165
Practice Address - Street 1:3356 WESTERN BRANCH BLVD
Practice Address - Street 2:#F
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5138
Practice Address - Country:US
Practice Address - Phone:757-673-3644
Practice Address - Fax:757-337-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034240208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty