MEDICARE: DR. BERNICE NATALIE MUCIUS-PENHA M.D.

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
1	207Q00000X	Family Medicine Physician	0116020317	VA
2	207Q00000X	Family Medicine Physician	0101249977	VA

General Provider Information

NPI Number	:	1568628527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNICE NATALIE MUCIUS-PENHA M.D.

Provider Business Mailing Address
First Line	:	14024 WILEY CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5578
Country	:	US
Telephone Number	:	516-673-8554
Fax Number	:	804-818-2637

Provider Business Practice Location Address
First Line	:	14024 WILEY CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5578
Country	:	US
Telephone Number	:	516-673-8554
Fax Number	:	804-818-2637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	02/12/2026

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