Organization
ADVANCED FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ANTHONY CLARK M.D. (CHAIRMAN)
(804) 347-4357
Entity
Organization
Contact information
Practice address
11453 ABBOTS CROSS LN, GLEN ALLEN, VA 23059-1102
(804) 347-4357
Mailing address
11453 ABBOTS CROSS LN, GLEN ALLEN, VA 23059-1102
(804) 347-4357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101032223
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005647134
—
VA
Enumeration date
09/20/2006
Last updated
01/08/2009
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