Basic Information
| Provider Information | |||||||||
| NPI: | 1871903682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VIRGINIA PSYCHIATRY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 1049 CLAYMONT DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245024481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403563556 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2014 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | LUEDKE | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5403453556 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.