Organization
CHRISTIANSBURG INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WASHINGTON (VP)
(703) 650-2907
Entity
Organization
Contact information
Practice address
95 PONDEROSA DR, CHRISTIANSBURG, VA 24073-6582
(540) 381-1882
Mailing address
95 PONDEROSA DR, CHRISTIANSBURG, VA 24073-6582
(540) 381-1882
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376583708
—
VA
01
—
DF3934
RR MEDICARE
—
Enumeration date
06/07/2006
Last updated
08/27/2007
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