| Family Medicine Of Lake Ridge | |
|
3401 Commission Ct Ste 201 Woodbridge VA 22192 | |
| (703) 490-6265 | |
| (703) 490-6713 |
| Full Name | Family Medicine Of Lake Ridge |
|---|---|
| Speciality | Family Medicine |
| Location | 3401 Commission Ct, Woodbridge, Virginia |
| Authorized Official Name and Position | Gerry A Cope (PHYSICIAN) |
| Authorized Official Contact | 7034906265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Of Lake Ridge 3401 Commission Ct Ste 201 Woodbridge VA 22192 Ph: (703) 490-6265 | Family Medicine Of Lake Ridge 3401 Commission Ct Ste 201 Woodbridge VA 22192 Ph: (703) 490-6265 |
| NPI Number | 1417045816 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0042370397 |
|---|---|
| Medicare Enrollment ID | O20081117000771 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417045816 | NPI | - | NPPES |
| Provider Name | Donna M Goodin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972700862 PECOS PAC ID: 8325118730 Enrollment ID: I20080528000222 |
| Provider Name | Peter A Mendel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043219629 PECOS PAC ID: 2567568389 Enrollment ID: I20100518000260 |
| Provider Name | John James Wierzbicki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316932809 PECOS PAC ID: 8022177047 Enrollment ID: I20121023000654 |
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