Unknown Individual – Internal Medicine Physician, NPI 1770581324
Internal Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Aubreys Loop, South Boston, Halifax County, Virginia, 23592, United States
SOUTH BOSTON, VA 245925056
Phone: (434) 517-3879
Fax: (434) 517-3989
Type: Mailing
1129, North Main Street, South Boston, Halifax County, Virginia, 24592, United States
SOUTH BOSTON, VA 245922557
Phone: (434) 575-6300
Fax: (434) 575-8300
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 24592)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| INTERNAL MEDICINE | VA | 90670 | Pneumococcal vaccine for injection into muscle | 37 | 37 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | VA | |
| General Surgery | VA | |
| Sports Medicine, Orthopedic Surgery | VA | |
| Orthopedic Surgery | VA | |
| Nurse Practitioner | VA | |
| Diagnostic Radiology | VA | |
| General Surgery | VA | |
| - | VA | |
| - | VA | |
| Diagnostic Radiology | VA |
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