# BOARD CERTIFIED FAMILY PRACTICE, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972715274
- **Authorized official:** GAUTAM DESAI (OWNER)
- **Authorized official phone:** (757) 471-6977

## Contact information

- **Practice address:** 2020 S INDEPENDENCE BLVD STE 3, VIRGINIA BEACH, VA 23453-4776
- **Practice address phone:** (757) 471-6977
- **Practice address fax:** (757) 471-5300
- **Mailing address:** 2020 S INDEPENDENCE BLVD STE 3, VIRGINIA BEACH, VA 23453-4776
- **Mailing address phone:** (757) 471-6977
- **Mailing address fax:** (757) 471-5300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101045379 | VA | Yes |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 03/14/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 005628881 | — | VA |
| 05 | — | 890666E | — | NC |