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676 Independence Pkwy Ste 110 Chesapeake VA 23320-5218 | |
(757) 372-4407 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 676 Independence Pkwy Ste 110, Chesapeake, Virginia |
Authorized Official Name and Position | Taylor Lawrence (BILLING MANAGER) |
Authorized Official Contact | 7573724407 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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732 Eden Way N Ste E104 Chesapeake VA 23320-2798 Ph: (757) 372-4407 | 676 Independence Pkwy Ste 110 Chesapeake VA 23320-5218 Ph: (757) 372-4407 |
NPI Number | 1053017475 |
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Provider Enumeration Date | 02/07/2023 |
Last Update Date | 05/21/2024 |
Medicare PECOS PAC ID | 7911449699 |
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Medicare Enrollment ID | O20240610001837 |
Identifier | Type | State | Issuer |
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1053017475 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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