Healthcare Provider Details

I. General information

NPI: 1730133398
Provider Name (Legal Business Name): FAMILY MEDICINE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/08/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 PORTSMOUTH BLVD
CHESAPEAKE VA
23321-3624
US

IV. Provider business mailing address

3925 PORTSMOUTH BLVD
CHESAPEAKE VA
23321-3624
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-3333
  • Fax: 757-488-0007
Mailing address:
  • Phone: 757-488-3333
  • Fax: 757-488-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101235873
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101028352
License Number StateVA

VIII. Authorized Official

Name: SAMIR TAWFIK ABDELSHAHEED
Title or Position: OWNER/ PHYSICIAN
Credential: M.D.
Phone: 757-488-3333