Engleside | |
8637 Engleside Office Park Alexandria VA 22309-4132 | |
(703) 535-5568 | |
(703) 535-1583 |
Full Name | Engleside |
---|---|
Speciality | Clinic/Center |
Location | 8637 Engleside Office Park, Alexandria, Virginia |
Authorized Official Name and Position | Basim Kahn (CEO) |
Authorized Official Contact | 7035355568 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Engleside Po Box 4320 Glen Allen VA 23058-4320 Ph: (703) 535-5568 | Engleside 8637 Engleside Office Park Alexandria VA 22309-4132 Ph: (703) 535-5568 |
NPI Number | 1154674026 |
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Provider Enumeration Date | 10/17/2012 |
Last Update Date | 05/13/2015 |
Medicare PECOS PAC ID | 7517853419 |
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Medicare Enrollment ID | O20040707000325 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154674026 | NPI | - | NPPES |
1164620027 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Martha Welman |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1316925977 PECOS PAC ID: 6709863889 Enrollment ID: I20040707000212 |
Provider Name | John Charles Reed |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1205932910 PECOS PAC ID: 8921063868 Enrollment ID: I20041119000873 |
Provider Name | Paula Rocha Hayes |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1922018761 PECOS PAC ID: 6305801440 Enrollment ID: I20041130000841 |
Provider Name | Dodd A. Sims |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1124006788 PECOS PAC ID: 7214968676 Enrollment ID: I20050825000241 |
Provider Name | Elise Barbara Morris |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1396789848 PECOS PAC ID: 6204860364 Enrollment ID: I20050919001097 |
Provider Name | Colin St Patrick Walters |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1538263199 PECOS PAC ID: 4880580786 Enrollment ID: I20051110000790 |
Provider Name | Pilar G Tam |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1356329916 PECOS PAC ID: 5890796536 Enrollment ID: I20070124000319 |
Provider Name | Daniel B Holtan |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093862864 PECOS PAC ID: 9638266489 Enrollment ID: I20071026000237 |
Provider Name | Lillian M Vagnoni |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1760672562 PECOS PAC ID: 6800977141 Enrollment ID: I20080114000066 |
Provider Name | Poornima Chandra |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1558543017 PECOS PAC ID: 1355311796 Enrollment ID: I20081029000242 |
Provider Name | Clarissa Marie Dudley |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1225204464 PECOS PAC ID: 5395804900 Enrollment ID: I20081111000271 |
Provider Name | Corry A Chapman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477712255 PECOS PAC ID: 2567529688 Enrollment ID: I20090317000320 |
Provider Name | Anjuli Jindal |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1043493372 PECOS PAC ID: 2668522111 Enrollment ID: I20090604000276 |
Provider Name | Courtney Riggle-van Schagen |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1316188568 PECOS PAC ID: 3779635529 Enrollment ID: I20090709000148 |
Provider Name | Paul B Kaplowitz |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1417038035 PECOS PAC ID: 3678610649 Enrollment ID: I20091023000134 |
Provider Name | Edda M Varona |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306881230 PECOS PAC ID: 8224178066 Enrollment ID: I20091229000585 |
Provider Name | Forouzandeh F Mofid-woo |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760458616 PECOS PAC ID: 8628060829 Enrollment ID: I20100127000343 |
Provider Name | Sharmila K Matippa |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710198494 PECOS PAC ID: 8921141656 Enrollment ID: I20100203000725 |
Provider Name | Lalitha S Rambhala |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1063568061 PECOS PAC ID: 8628104312 Enrollment ID: I20100406000188 |
Provider Name | Carmella Ann Cole |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1922057314 PECOS PAC ID: 0143357830 Enrollment ID: I20100429000275 |
Provider Name | Rebecca A Stone |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356408561 PECOS PAC ID: 9436275450 Enrollment ID: I20100928000708 |
Provider Name | Jennifer Machell Sims |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417088386 PECOS PAC ID: 1355481706 Enrollment ID: I20110408000607 |
Provider Name | Basim N Khan |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1477880045 PECOS PAC ID: 3577723931 Enrollment ID: I20120322000550 |
Provider Name | Jacqueline Elise Pokusa |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1104178094 PECOS PAC ID: 1951539048 Enrollment ID: I20140117000670 |
Provider Name | Julia Lynn Skapik |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1386800431 PECOS PAC ID: 8921286451 Enrollment ID: I20140911001651 |
Provider Name | Christine Marie Page-lopez |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1932498532 PECOS PAC ID: 7911127642 Enrollment ID: I20141001001536 |
Provider Name | Ruhi H Lakhani |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871998625 PECOS PAC ID: 3173846078 Enrollment ID: I20141230000482 |
Provider Name | Susana Melissa Vega |
---|---|
Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
Provider Identifiers | NPI Number: 1578805727 PECOS PAC ID: 6608199260 Enrollment ID: I20150107000132 |
Provider Name | Jose Antonio Segura |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1265699169 PECOS PAC ID: 9931428935 Enrollment ID: I20150424000415 |
Provider Name | Shannon Mcwilliams |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1821234733 PECOS PAC ID: 0345551941 Enrollment ID: I20150624000424 |
Provider Name | Jacqueline V Zamora |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598147522 PECOS PAC ID: 0446565840 Enrollment ID: I20150813011667 |
Provider Name | Ekta Srikumar |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1669600862 PECOS PAC ID: 6305151408 Enrollment ID: I20150819006921 |
Provider Name | Mariama Boie Jalloh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164805529 PECOS PAC ID: 7416266911 Enrollment ID: I20160115000505 |
Provider Name | Lesley Elizabeth Magnussen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538479225 PECOS PAC ID: 5193960151 Enrollment ID: I20160906000407 |
Provider Name | Jewel B Osborne-wu |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003175589 PECOS PAC ID: 6305069865 Enrollment ID: I20161005000162 |
Provider Name | Manasi Pandit Long |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1821432097 PECOS PAC ID: 9234420506 Enrollment ID: I20161114000872 |
Provider Name | Lisa M Gittleman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982670303 PECOS PAC ID: 5597046599 Enrollment ID: I20170109001135 |
Provider Name | Colette Thorpe Knudsen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639406317 PECOS PAC ID: 9436282654 Enrollment ID: I20171116001515 |
Provider Name | Alma C Tobar |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598277139 PECOS PAC ID: 3870853625 Enrollment ID: I20180216000374 |
Provider Name | Thomas E Burns |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1558416552 PECOS PAC ID: 6406017599 Enrollment ID: I20180315000127 |
Provider Name | Amanjot Kaur |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1114283348 PECOS PAC ID: 2062641012 Enrollment ID: I20180508001897 |
Provider Name | Tabassum Shamim |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1538185616 PECOS PAC ID: 1850345802 Enrollment ID: I20180517001535 |
Provider Name | Zain Jalal Sultan |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073033031 PECOS PAC ID: 9133498389 Enrollment ID: I20180926000266 |
Provider Name | Natasha Singh |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962898700 PECOS PAC ID: 7113227174 Enrollment ID: I20190107002886 |
Provider Name | Megan Lear Prior |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1649664194 PECOS PAC ID: 1557673449 Enrollment ID: I20190507001365 |
Provider Name | Janessa Rose Six |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578029781 PECOS PAC ID: 3476895749 Enrollment ID: I20190507001785 |
Provider Name | Sarah Renee Chapman |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1386296374 PECOS PAC ID: 8426386301 Enrollment ID: I20190830000754 |
Provider Name | Cathy Ann Gallagher |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679633952 PECOS PAC ID: 3779814124 Enrollment ID: I20191016000670 |
Provider Name | Shantanu Nundy |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1891950606 PECOS PAC ID: 2961673256 Enrollment ID: I20191125000385 |
Provider Name | Fernando Luis Ortiz |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1255318010 PECOS PAC ID: 5294167680 Enrollment ID: I20191125001126 |
Provider Name | Whitney Alyse Osborn |
---|---|
Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
Provider Identifiers | NPI Number: 1578932331 PECOS PAC ID: 8729410113 Enrollment ID: I20191125001206 |
Provider Name | Giorgos Hadjivassiliou |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1215342621 PECOS PAC ID: 7618194713 Enrollment ID: I20191126000868 |
Provider Name | Cynthia Ivette Lopez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669848438 PECOS PAC ID: 2567762628 Enrollment ID: I20191204002448 |
Provider Name | Elizabeth Eunbee Suh |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1497188155 PECOS PAC ID: 7012208879 Enrollment ID: I20191205000026 |
Provider Name | Maria Yolanda Giraldo Jimenez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518301779 PECOS PAC ID: 3971938929 Enrollment ID: I20200121001504 |
Provider Name | Erin Elizabeth Wisman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1770845315 PECOS PAC ID: 1557599743 Enrollment ID: I20200123000614 |
Provider Name | Camarita Bih Titang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437798873 PECOS PAC ID: 0446688105 Enrollment ID: I20200312001317 |
Provider Name | Rubina Michael Dolvane |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1144433590 PECOS PAC ID: 8325476484 Enrollment ID: I20200324001164 |
Provider Name | Erin Latrice Palmer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154708204 PECOS PAC ID: 5193052561 Enrollment ID: I20200418000467 |
Provider Name | Cindy Sue Anderson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1407057631 PECOS PAC ID: 8224189220 Enrollment ID: I20200615000333 |
Provider Name | Prathima Polepalli Setty |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1861435117 PECOS PAC ID: 6901840164 Enrollment ID: I20200622000155 |
Provider Name | Carolina M Saldarriaga Perez |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1235659228 PECOS PAC ID: 0840618534 Enrollment ID: I20200911002071 |
Provider Name | Karleny I. Beltran Alvarado |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881229870 PECOS PAC ID: 8325466964 Enrollment ID: I20200915001044 |
Provider Name | Danielle Grams Engskow |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1972037315 PECOS PAC ID: 8921428103 Enrollment ID: I20201009001945 |
Provider Name | Norma Mowaffak Chamma |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1457880759 PECOS PAC ID: 2466872536 Enrollment ID: I20201013000085 |
Provider Name | Sarah B Frantz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992314868 PECOS PAC ID: 2062827710 Enrollment ID: I20210211000160 |
Provider Name | Joelle L Gelmann |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679947675 PECOS PAC ID: 8820403439 Enrollment ID: I20210211003531 |
Provider Name | Sophie Presny |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316544588 PECOS PAC ID: 2769897065 Enrollment ID: I20210218002580 |
Provider Name | Alissa L Wong |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356948079 PECOS PAC ID: 5193133023 Enrollment ID: I20210414001498 |
Provider Name | Calla E Michalak |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902484751 PECOS PAC ID: 4082014063 Enrollment ID: I20210614000116 |
Provider Name | Aisha Sesay |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841876000 PECOS PAC ID: 6305246265 Enrollment ID: I20210615000007 |
Provider Name | Eduardo Jesus Mariel |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1053355461 PECOS PAC ID: 0042269433 Enrollment ID: I20210831001448 |
Provider Name | Lisa Ann Wiener |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942367990 PECOS PAC ID: 3476682055 Enrollment ID: I20211217001207 |
Provider Name | Shannon Jihye Hwang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659913143 PECOS PAC ID: 4183018401 Enrollment ID: I20220303000630 |
Provider Name | Timothy Leroy Marshall |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1275645376 PECOS PAC ID: 2860412350 Enrollment ID: I20220310000047 |
Provider Name | Crinela Fica Todea |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568685097 PECOS PAC ID: 6709801178 Enrollment ID: I20220712000623 |
Provider Name | Bethsy Daverman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982164497 PECOS PAC ID: 8022346279 Enrollment ID: I20220921003718 |
Provider Name | Molly Fonseca |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891369757 PECOS PAC ID: 2264822840 Enrollment ID: I20220926000305 |
Provider Name | Alexandra Laughlin Nalewanski |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1962061630 PECOS PAC ID: 8426434648 Enrollment ID: I20220926001719 |
Provider Name | Monica Gupta |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356801807 PECOS PAC ID: 9234515909 Enrollment ID: I20221004000299 |
Provider Name | Mariya Abbas Mohammed |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1770046401 PECOS PAC ID: 9830566801 Enrollment ID: I20221103001778 |
Provider Name | Joann Ordaz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013388537 PECOS PAC ID: 0941226617 Enrollment ID: I20230115000018 |
Provider Name | Natalie Lourdes Lima-garcia |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669105151 PECOS PAC ID: 1456722107 Enrollment ID: I20230117002904 |
Provider Name | Jennifer Alexis Horton |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1881695054 PECOS PAC ID: 1153301965 Enrollment ID: I20230214001556 |
Provider Name | John Raymond Brinjak |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1699335851 PECOS PAC ID: 7517292352 Enrollment ID: I20230524000030 |
Provider Name | Sara Mae Steward |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164051470 PECOS PAC ID: 4385064674 Enrollment ID: I20230524000041 |
Provider Name | Luis Felipe Cebas |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1962973784 PECOS PAC ID: 3779941174 Enrollment ID: I20230616000753 |
Provider Name | Melissa Hanna Simkol |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1043831266 PECOS PAC ID: 7719349158 Enrollment ID: I20230816002232 |
Provider Name | David James Killeen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1568925659 PECOS PAC ID: 0446588164 Enrollment ID: I20231111000332 |
Provider Name | Elissa Delong |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073924486 PECOS PAC ID: 2365717568 Enrollment ID: I20240212001559 |
Provider Name | James Gavin Wallace-mercado |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023744406 PECOS PAC ID: 0941643365 Enrollment ID: I20240213000950 |
Provider Name | Camilla Monika Maybee |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548885494 PECOS PAC ID: 7517381106 Enrollment ID: I20240213002218 |
Provider Name | Ana Maria Espinoza |
---|---|
Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1740646231 PECOS PAC ID: 4981049988 Enrollment ID: I20240229002491 |
Provider Name | Anna Jaroszewska |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1588071294 PECOS PAC ID: 3779873013 Enrollment ID: I20240417004094 |
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