Provider Demographics
NPI:1174551725
Name:HALIFAXMED, PLC
Entity type:Organization
Organization Name:HALIFAXMED, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-1171
Mailing Address - Street 1:1627 SEYMOUR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3428
Mailing Address - Country:US
Mailing Address - Phone:434-572-1171
Mailing Address - Fax:434-572-1776
Practice Address - Street 1:1627 SEYMOUR DR
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3428
Practice Address - Country:US
Practice Address - Phone:434-572-9355
Practice Address - Fax:434-572-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty