| Med Mgt Associates Of Virginia Llc | |
|
688 Kingsborough Sq Chesapeake VA 23320-4908 | |
| (757) 547-9111 | |
| Not Available |
| Full Name | Med Mgt Associates Of Virginia Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 688 Kingsborough Sq, Chesapeake, Virginia |
| Authorized Official Name and Position | Paul A Boskind (CEO-OWNER) |
| Authorized Official Contact | 2102242106 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Med Mgt Associates Of Virginia Llc 7272 Wurzbach Rd Ste 601 San Antonio TX 78240-4803 Ph: (210) 615-3483 | Med Mgt Associates Of Virginia Llc 688 Kingsborough Sq Chesapeake VA 23320-4908 Ph: (757) 547-9111 |
| NPI Number | 1104307834 |
|---|---|
| Provider Enumeration Date | 08/21/2018 |
| Last Update Date | 12/11/2018 |
| Medicare PECOS PAC ID | 6406190826 |
|---|---|
| Medicare Enrollment ID | O20181211003175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104307834 | NPI | - | NPPES |
| 0101265222 | Other | VA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 0101265222 (Virginia) | Primary |
| Provider Name | Shelly R Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457630774 PECOS PAC ID: 8022288075 Enrollment ID: I20110830000319 |
| Provider Name | Chantz Bury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356990261 PECOS PAC ID: 3971834375 Enrollment ID: I20191016002567 |
| Provider Name | Aaron Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023455649 PECOS PAC ID: 5193952968 Enrollment ID: I20200403001963 |
| Provider Name | Kateria Sha'kee Carter Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699375964 PECOS PAC ID: 9335552488 Enrollment ID: I20210108001227 |
| Provider Name | Riaz Rahman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275630717 PECOS PAC ID: 8729077235 Enrollment ID: I20230322002614 |
| Provider Name | Shannon Leigh Burnette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932293362 PECOS PAC ID: 1759418569 Enrollment ID: I20230623001178 |
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