Basic Information
| Provider Information | |||||||||
| NPI: | 1568439040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POEHAILOS | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | DEMBECK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 RIVERBEND DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349844200 | ||||||||
| FaxNumber: | 4349846242 | ||||||||
| Practice Location | |||||||||
| Address1: | 3370 PUMP RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232331130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043608061 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101046855 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 0101046855 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5617081 | 05 | VA | MEDICAID |