Provider Demographics
NPI:1902247109
Name:UVA COMMUNITY HEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:UVA COMMUNITY HEALTH MEDICAL GROUP, LLC
Other - Org Name:UVA HEALTH BREAST SURGERY HAYMARKET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-835-2069
Mailing Address - Street 1:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6244
Practice Address - Country:US
Practice Address - Phone:571-284-3380
Practice Address - Fax:571-284-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2023-09-26
Deactivation Date:2023-09-11
Deactivation Code:
Reactivation Date:2023-09-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty