Provider Demographics
NPI:1871709899
Name:ADULT AND PEDIATRIC MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ADULT AND PEDIATRIC MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LUKIA
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:757-484-2001
Mailing Address - Street 1:3800 POPLAR HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5522
Mailing Address - Country:US
Mailing Address - Phone:757-484-2001
Mailing Address - Fax:757-484-2182
Practice Address - Street 1:3800 POPLAR HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-484-2001
Practice Address - Fax:757-484-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224920261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010060169Medicaid
VA010060133Medicaid
VAH83127Medicare UPIN
VA010060169Medicaid
VA010060133Medicaid