| Board Certified Family Practice, Inc | |
|
2020 S Independence Blvd Ste 3 Virginia Beach VA 23453-4776 | |
| (757) 471-6977 | |
| (757) 471-5300 |
| Full Name | Board Certified Family Practice, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2020 S Independence Blvd Ste 3, Virginia Beach, Virginia |
| Authorized Official Name and Position | Gautam Desai (OWNER) |
| Authorized Official Contact | 7574716977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Certified Family Practice, Inc 2020 S Independence Blvd Ste 3 Virginia Beach VA 23453-4776 Ph: (757) 471-6977 | Board Certified Family Practice, Inc 2020 S Independence Blvd Ste 3 Virginia Beach VA 23453-4776 Ph: (757) 471-6977 |
| NPI Number | 1972715274 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 03/14/2012 |
| Medicare PECOS PAC ID | 5799966701 |
|---|---|
| Medicare Enrollment ID | O20110224000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972715274 | NPI | - | NPPES |
| 890666E | Medicaid | NC | |
| 005628881 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101045379 (Virginia) | Primary |
| Provider Name | Gautam D Desai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417047663 PECOS PAC ID: 9133300155 Enrollment ID: I20110224000268 |
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