MEDICARE: NANSEMOND FAMILY PRACTICE, LLC

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	0101045475	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24513	OTHER	VA	OPTIMA HEALTH/SENTARA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	431477	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1245313857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANSEMOND FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	206 GUMWOOD DR
Second Line	:	SUITE A
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-6087
Country	:	US
Telephone Number	:	757-365-9090
Fax Number	:	757-365-9095

Provider Business Practice Location Address
First Line	:	206 GUMWOOD DR
Second Line	:	SUITE A
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-6087
Country	:	US
Telephone Number	:	757-365-9090
Fax Number	:	757-365-9095

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DONALD ELWOOD SOLES JR.
Credential	:	M.D.
Telephone Number	:	757-365-9090

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/14/2011

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Directions to “NANSEMOND FAMILY PRACTICE, LLC ” Practice Location

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