MEDICARE: DR. JOSEPH W FAMILANT MD

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	208000000X	Pediatrics Physician	0101017379	VA

General Provider Information

NPI Number	:	1508903550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH W FAMILANT MD

Provider Business Mailing Address
First Line	:	PO BOX 2002
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23450-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 THURSTON AVE STE 107
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3302
Country	:	US
Telephone Number	:	757-363-3808
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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