| Victa Llc | |
|
110 Elmwood Ave # A Providence RI 02907 | |
| (401) 868-0654 | |
| Not Available |
| Full Name | Victa Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 110 Elmwood Ave # A, Providence, Rhode Island |
| Authorized Official Name and Position | Alexander Donoyan (CEO) |
| Authorized Official Contact | 4013005757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victa Llc 110 Elmwood Ave Providence RI 02907-2423 Ph: (401) 300-5757 | Victa Llc 110 Elmwood Ave # A Providence RI 02907 Ph: (401) 868-0654 |
| NPI Number | 1104317007 |
|---|---|
| Provider Enumeration Date | 05/25/2018 |
| Last Update Date | 02/21/2019 |
| Medicare PECOS PAC ID | 0840620894 |
|---|---|
| Medicare Enrollment ID | O20200415002461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104317007 | NPI | - | NPPES |
| Provider Name | Karen Mcdonald |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1841236718 PECOS PAC ID: 5890762470 Enrollment ID: I20040914000004 |
| Provider Name | Michael James Weaver |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1215995097 PECOS PAC ID: 3779548623 Enrollment ID: I20041119000940 |
| Provider Name | Cheryl Brodsky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376523829 PECOS PAC ID: 8325004815 Enrollment ID: I20041207000236 |
| Provider Name | Ramona L Mello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295875516 PECOS PAC ID: 1153417977 Enrollment ID: I20071009000979 |
| Provider Name | Jeremy S Thayer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518094846 PECOS PAC ID: 1557410636 Enrollment ID: I20090520000124 |
| Provider Name | Sylvester C Sviokla |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1205850989 PECOS PAC ID: 1850722422 Enrollment ID: I20200514002173 |
| Provider Name | Lisa Marie Rodrigues |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639454572 PECOS PAC ID: 3476728858 Enrollment ID: I20220107001899 |
| Provider Name | Lisa A Peterson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962514869 PECOS PAC ID: 3577993526 Enrollment ID: I20240426000159 |
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