Organization
LAKESIDE MEDICAL ASSOCIATES PC
Active
Organization
LAKESIDE MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJAY JAIN MD (MANAGER)
(434) 447-8081
Entity
Organization
Contact information
Practice address
200 E FERRELL ST, SOUTH HILL, VA 23970-2104
(434) 447-8081
(434) 447-8202
Mailing address
PO BOX 999, SOUTH HILL, VA 23970-0999
(434) 447-8081
(434) 447-8202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD2229
RAILROAD MEDICARE
—
Enumeration date
07/04/2006
Last updated
10/15/2007
Update your record
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