Basic Information
| Provider Information | |||||||||
| NPI: | 1831190800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGNANT | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12184 OLD RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | DOSWELL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230472215 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5801 BREMO RD | ||||||||
| Address2: | VIRGINIA EMERGENCY ASSOCIATES INC | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042877066 | ||||||||
| FaxNumber: | 8046739531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 11/06/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101033356 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.