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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE VA PLLC

MEDICARE: CENTERWELL SENIOR PRIMARY CARE VA PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician
2207Q00000XFamily Medicine Physician
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1144920497
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE VA PLLC
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1118 W MERCURY BLVD
Second Line :
City : HAMPTON
State : VA
Zip : 23666-3328
Country : US
Telephone Number : 757-276-9526
Fax Number : 877-487-2116
Authorized Official
Title or Position : SENIR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 03/06/2023
Last Update Date : 08/19/2024

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