MEDICARE: NEPHROLOGY SPECIALISTS PC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1578645107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY SPECIALISTS PC

Provider Business Mailing Address
First Line	:	7501 RIGHT FLANK RD STE 600
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3863
Country	:	US
Telephone Number	:	804-559-6980
Fax Number	:	804-559-6982

Provider Business Practice Location Address
First Line	:	7501 RIGHT FLANK RD STE 600
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3863
Country	:	US
Telephone Number	:	804-559-6980
Fax Number	:	804-559-6982

Authorized Official
Title or Position	:	CREDENTIALING/BILLING ADMINISTRATOR
Name	:	TERESA LYNN STEVENS
Credential	:
Telephone Number	:	804-559-6980

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/24/2026

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Practice Location Address:

7501 RIGHT FLANK RD STE 600
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1447256482 — GERALD E KEIGHTLEY M.D.
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1265566772 — SEABORN MCDONALD WADE III M.D.
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7501 RIGHT FLANK RD , SUITE 600
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23116-3863

Practice Phone: 804-559-2489
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1538331939 — ANGELA ROSE VANLANDINGHAM M.D.
Practice Location Address:

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1669748034 — RACHEL CLOUTIER NP
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