| Mid Atlantic Long Term Specialty Care Llc | |
|
6160 Kempsville Cir Ste 325a Norfolk VA 23502-3933 | |
| (757) 354-2885 | |
| (757) 917-5141 |
| Full Name | Mid Atlantic Long Term Specialty Care Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6160 Kempsville Cir Ste 325a, Norfolk, Virginia |
| Authorized Official Name and Position | Nabil Tadros (SOLE MEMBER) |
| Authorized Official Contact | 7573542885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Atlantic Long Term Specialty Care Llc 6160 Kempsville Cir Ste 325a Norfolk VA 23502-3933 Ph: (757) 354-2885 | Mid Atlantic Long Term Specialty Care Llc 6160 Kempsville Cir Ste 325a Norfolk VA 23502-3933 Ph: (757) 354-2885 |
| NPI Number | 1851909998 |
|---|---|
| Provider Enumeration Date | 07/15/2020 |
| Last Update Date | 07/15/2020 |
| Certification Date | 07/15/2020 |
| Medicare PECOS PAC ID | 8921427162 |
|---|---|
| Medicare Enrollment ID | O20201007001831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851909998 | NPI | - | NPPES |
| Provider Name | Raina Nyomi Winfrey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407893811 PECOS PAC ID: 4385543099 Enrollment ID: I20031231000687 |
| Provider Name | Glenn R Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851439061 PECOS PAC ID: 2961492087 Enrollment ID: I20040512001133 |
| Provider Name | Nabil T. M. Tadros |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982684692 PECOS PAC ID: 8921088352 Enrollment ID: I20040724000351 |
| Provider Name | Roseanne Newman |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1265408736 PECOS PAC ID: 8628044468 Enrollment ID: I20040902001445 |
| Provider Name | Sharon Petitjean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497731301 PECOS PAC ID: 2264513100 Enrollment ID: I20080116000538 |
| Provider Name | Lee Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831308964 PECOS PAC ID: 2163505272 Enrollment ID: I20080215000591 |
| Provider Name | Kavitha Tatineni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568754604 PECOS PAC ID: 5799961249 Enrollment ID: I20110517000617 |
| Provider Name | Ruth M Pence |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598085177 PECOS PAC ID: 9739332289 Enrollment ID: I20130111000116 |
| Provider Name | Kiniya C Church |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215352554 PECOS PAC ID: 1951524305 Enrollment ID: I20140603002231 |
| Provider Name | Ameanthea Rt Blanco Knezovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003032095 PECOS PAC ID: 9830314400 Enrollment ID: I20140910002465 |
| Provider Name | Angela Marie Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821481995 PECOS PAC ID: 8820318876 Enrollment ID: I20150514002935 |
| Provider Name | Donna Marie Sotolongo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851824791 PECOS PAC ID: 1456629815 Enrollment ID: I20170608000910 |
| Provider Name | Anne L White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043714850 PECOS PAC ID: 1951651132 Enrollment ID: I20181126000736 |
| Provider Name | Erica Jane Canaday |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114575750 PECOS PAC ID: 4981935822 Enrollment ID: I20191008002277 |
| Provider Name | Naomi S Myrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700430733 PECOS PAC ID: 8921330358 Enrollment ID: I20191104002383 |
| Provider Name | Alfreda Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356997613 PECOS PAC ID: 4587091780 Enrollment ID: I20200228000669 |
| Provider Name | Jessica Loren Rosa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083234637 PECOS PAC ID: 2365873106 Enrollment ID: I20200512002611 |
| Provider Name | Danielle Renea Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427307438 PECOS PAC ID: 0840602819 Enrollment ID: I20201216000191 |
| Provider Name | John Charles Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508498676 PECOS PAC ID: 6507267218 Enrollment ID: I20210701000109 |
| Provider Name | Sarah J Mcbride |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780321992 PECOS PAC ID: 1355726639 Enrollment ID: I20220922003032 |
| Provider Name | Lena Villanueva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912617812 PECOS PAC ID: 0143691741 Enrollment ID: I20230118001833 |
| Provider Name | Alice Baillio-hanchey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700669363 PECOS PAC ID: 7618322926 Enrollment ID: I20231005003619 |
| Provider Name | Therese Nicole Morin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316721608 PECOS PAC ID: 1355790908 Enrollment ID: I20231208000757 |
| Provider Name | Tara Higginbotham Rouse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790555621 PECOS PAC ID: 9931550043 Enrollment ID: I20240112001227 |
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