Provider Demographics
NPI:1801072194
Name:GEORGE MEYERHOFF
Entity type:Organization
Organization Name:GEORGE MEYERHOFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-484-4870
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-484-4870
Mailing Address - Fax:804-484-4873
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-484-4870
Practice Address - Fax:804-484-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010122667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5872448Medicaid
VAC36610Medicare UPIN
VA5872448Medicaid