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General NPI Number Information
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NPI Number | 1013411842
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Entity Type | Organization
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Legal Business Name | WELLFAMILY MEDICINE
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1885 SEMINOLE TRL STE 105
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1160
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Country | US
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Telephone | 434-962-6234
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Fax |
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Provider Business Mailing Address
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Address Line | 1885 SEMINOLE TRL STE 105
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1160
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Country | US
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Telephone | 434-962-6234
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KAITLYN ANNE BEISECKER-LEVIN
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Credential | MD
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Telephone | 434-962-6234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101246861
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License Number State | VA
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