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Organization
1212 MED PLLC
Active
Organization
1212 MED PLLC
Active
Other names
1212MED
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY BURGESS MD (OWNER)
(540) 682-3082
Entity
Organization
Contact information
Practice address
405 E LABURNUM AVE STE 3, RICHMOND, VA 23222-2134
(540) 200-8821
(540) 779-7889
Mailing address
674 LEES GAP RD, FINCASTLE, VA 24090-3869
(540) 682-3082
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2023
Last updated
03/07/2024
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