Organization
BOARD CERTIFIED FAMILY PRACTICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAUTAM DESAI (OWNER)
(757) 471-6977
Entity
Organization
Contact information
Practice address
2020 S INDEPENDENCE BLVD STE 3, VIRGINIA BEACH, VA 23453-4776
(757) 471-6977
(757) 471-5300
Mailing address
2020 S INDEPENDENCE BLVD STE 3, VIRGINIA BEACH, VA 23453-4776
(757) 471-6977
(757) 471-5300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101045379
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005628881
—
VA
05
—
890666E
—
NC
Enumeration date
05/07/2007
Last updated
03/14/2012
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