| NPI | 1164076634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELEANOR ALTMAN PRESCOTT Gove RN Ment Program Manager 540-224-5379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2025-12-15 |