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Specialty details in registry · Charlottesville, VA

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At a glance

590 Peter Jefferson Pkwy, Charlottesville, VA 22911-4628

NPPES record updated Oct 1, 2025. Public records can lag behind changes at a practice.

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Practice location

590 Peter Jefferson Pkwy Suite 175, Room172
Charlottesville, VA 22911-4628

Professional details: NPI, taxonomy & registry record

NPI1790399202

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 3336C0003X
Enumeration date: Sep 2, 2020
Record updated: Oct 1, 2025

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

3336C0003X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

590 Peter Jefferson Pkwy
Suite 175, Room172
Charlottesville, VA 22911-4628

Phone: (434) 297-8840

Mailing address

PO BOX 800750

CHARLOTTESVILLE, VA 229080750

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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