Physician Compare National (NPI:1265660203)

HEALTHCARE PROVIDER: CHARYSSE JOHNSTON MANOUILOV MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1265660203
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8325281108
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130826001033
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MANOUILOV
	Individual professional last name
Provider First Name	CHARYSSE
	Individual professional first name
Provider Middle Name	JOHNSTON
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MID ATLANTIC WOMENS CARE PLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8820998156
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	82
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1181 1ST COLONIAL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	VIRGINIA BEACH
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	234542437
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7574251600
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y