| Lifetime Family Medicine, Llc | |
|
14535 John Marshall Hwy Suite 105 Gainesville VA 20155-4023 | |
| (703) 754-0425 | |
| (703) 754-2888 |
| Full Name | Lifetime Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 14535 John Marshall Hwy, Gainesville, Virginia |
| Authorized Official Name and Position | Theresa Belben Shupe (OWNER) |
| Authorized Official Contact | 7037540425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Family Medicine, Llc 14535 John Marshall Hwy Suite 105 Gainesville VA 20155-4023 Ph: (703) 754-0425 | Lifetime Family Medicine, Llc 14535 John Marshall Hwy Suite 105 Gainesville VA 20155-4023 Ph: (703) 754-0425 |
| NPI Number | 1134214356 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 07/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134214356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101058775 (Virginia) | Primary |
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