MEDICARE: LORELLA ADDIS PA-C

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	363A00000X	Physician Assistant	NA 050936	PA
2	363A00000X	Physician Assistant	0110007629	VA

General Provider Information

NPI Number	:	1851337273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORELLA ADDIS PA-C

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N LYNNHAVEN RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7523
Country	:	US
Telephone Number	:	866-934-7450
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	04/05/2023

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Directions to “ LORELLA ADDIS PA-C” Practice Location

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