| Novant Health Village Family Care | |
|
3213 Rogers Road Wake Forest NC 27587-3805 | |
| (919) 562-2288 | |
| (919) 562-2225 |
| Full Name | Novant Health Village Family Care |
|---|---|
| Speciality | Family Medicine |
| Location | 3213 Rogers Road, Wake Forest, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Novant Health Village Family Care Po Box 60447 Charlotte NC 28260-0447 Ph: (919) 562-2288 | Novant Health Village Family Care 3213 Rogers Road Wake Forest NC 27587-3805 Ph: (919) 562-2288 |
| NPI Number | 1659571768 |
|---|---|
| Provider Enumeration Date | 07/18/2007 |
| Last Update Date | 07/09/2024 |
| Medicare PECOS PAC ID | 1153234893 |
|---|---|
| Medicare Enrollment ID | O20080207000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659571768 | NPI | - | NPPES |
| 5907996 | Medicaid | NC | |
| 020E0 | Other | NC | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (North Carolina) | Primary |
| Provider Name | Shelia M Smalls Stokes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629011481 PECOS PAC ID: 3971497132 Enrollment ID: I20040210000478 |
| Provider Name | Scott E Konopka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669409686 PECOS PAC ID: 8820058936 Enrollment ID: I20041013000839 |
| Provider Name | Howard Andrew Kraft |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326097262 PECOS PAC ID: 2062456361 Enrollment ID: I20050617000109 |
| Provider Name | Thomas Weber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487628723 PECOS PAC ID: 1052494598 Enrollment ID: I20080207000266 |
| Provider Name | Ifeanyi Iwuchukwu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215169974 PECOS PAC ID: 6608056312 Enrollment ID: I20110214000313 |
| Provider Name | Andrew B Evans |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063692721 PECOS PAC ID: 7315116100 Enrollment ID: I20110811000846 |
| Provider Name | Barbara J Paolucci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851650196 PECOS PAC ID: 3779730668 Enrollment ID: I20120828000899 |
| Provider Name | Dittana Phoncharoensri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750585170 PECOS PAC ID: 1658411509 Enrollment ID: I20130719000434 |
| Provider Name | Mateo Calderon Arnulphi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811159957 PECOS PAC ID: 0143454496 Enrollment ID: I20141218001784 |
| Provider Name | Sam Saha |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629394390 PECOS PAC ID: 3870733181 Enrollment ID: I20150107000141 |
| Provider Name | Jose Luis Vega |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558503458 PECOS PAC ID: 1850583790 Enrollment ID: I20150724010582 |
| Provider Name | Jessica R Parker |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063702306 PECOS PAC ID: 4880834696 Enrollment ID: I20151110002280 |
| Provider Name | Qaiser Toqeer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093079048 PECOS PAC ID: 3173764446 Enrollment ID: I20160810001178 |
| Provider Name | Javon Miguel Edgecombe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255622015 PECOS PAC ID: 2961635115 Enrollment ID: I20160830001100 |
| Provider Name | Jonathan Diaz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578856159 PECOS PAC ID: 8224255633 Enrollment ID: I20161017000019 |
| Provider Name | Zulfiqar Turk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972794014 PECOS PAC ID: 8628233194 Enrollment ID: I20161027001891 |
| Provider Name | Nancy Dominique Rosales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1114246717 PECOS PAC ID: 3476776147 Enrollment ID: I20180517000130 |
| Provider Name | Arvind Muralimohan Gomadam |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811417835 PECOS PAC ID: 5294086203 Enrollment ID: I20181001001550 |
| Provider Name | Jomar S Roberts |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295904993 PECOS PAC ID: 7719023993 Enrollment ID: I20181024002199 |
| Provider Name | Meghan Lucy Clair Gamelin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902289499 PECOS PAC ID: 8820301682 Enrollment ID: I20181114001614 |
| Provider Name | Syed Shiraz Hyder |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245383108 PECOS PAC ID: 1951395938 Enrollment ID: I20181212002478 |
| Provider Name | Nimit Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770997108 PECOS PAC ID: 8426342171 Enrollment ID: I20200302001125 |
| Provider Name | Siddhartha Varma |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598920225 PECOS PAC ID: 9931348687 Enrollment ID: I20210713001643 |
| Provider Name | Robert Casper Wiggins |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386006872 PECOS PAC ID: 9739473455 Enrollment ID: I20210723001127 |
| Provider Name | Jessica Atkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932841608 PECOS PAC ID: 9537547245 Enrollment ID: I20220609000530 |
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