Provider Demographics
NPI:1366622326
Name:INTERNAL MEDICINE OF WILLIAMSBURG, INC.
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF WILLIAMSBURG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:HUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-564-8182
Mailing Address - Street 1:227 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5649
Mailing Address - Country:US
Mailing Address - Phone:757-564-8182
Mailing Address - Fax:757-564-0077
Practice Address - Street 1:227 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5649
Practice Address - Country:US
Practice Address - Phone:757-564-8182
Practice Address - Fax:757-564-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09008OtherMEDICARE PROVIDER NUMBER
VAC09008Medicare PIN
VAC09008Medicare UPIN