Provider Demographics
NPI:1902889363
Name:PANTOPS FAMILY MEDICINE PLC
Entity Type:Organization
Organization Name:PANTOPS FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-979-4440
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-982-7794
Mailing Address - Fax:434-982-7752
Practice Address - Street 1:1490 PANTOPS MOUNTAIN PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4601
Practice Address - Country:US
Practice Address - Phone:434-979-4440
Practice Address - Fax:434-979-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08240Medicare PIN
VACJ7558Medicare PIN