| Meditelecare Of Virginia, Llc | |
|
4701 Cox Rd Ste 285 Glen Allen VA 23060-6808 | |
| (860) 788-6404 | |
| (860) 829-0495 |
| Full Name | Meditelecare Of Virginia, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4701 Cox Rd Ste 285, Glen Allen, Virginia |
| Authorized Official Name and Position | Andrea Godfrey (CREDENT AND ENROLLMENT MANAGER) |
| Authorized Official Contact | 8602742418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of Virginia, Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of Virginia, Llc 4701 Cox Rd Ste 285 Glen Allen VA 23060-6808 Ph: (860) 788-6404 |
| NPI Number | 1851890321 |
|---|---|
| Provider Enumeration Date | 02/09/2018 |
| Last Update Date | 12/27/2023 |
| Certification Date | 12/27/2023 |
| Medicare PECOS PAC ID | 2163785973 |
|---|---|
| Medicare Enrollment ID | O20180409002025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851890321 | NPI | - | NPPES |
| Provider Name | Stephanie Ann White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952364267 PECOS PAC ID: 7719934181 Enrollment ID: I20051229000681 |
| Provider Name | Errol Segall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407855190 PECOS PAC ID: 8022290543 Enrollment ID: I20120210000013 |
| Provider Name | Cristina Ruzila |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568727550 PECOS PAC ID: 5799939039 Enrollment ID: I20130801000512 |
| Provider Name | Barbara Hutchinson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528255643 PECOS PAC ID: 8426284308 Enrollment ID: I20131125000455 |
| Provider Name | Shoshana R Lewin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932286044 PECOS PAC ID: 8820309669 Enrollment ID: I20150619000644 |
| Provider Name | Angelique Butler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730495763 PECOS PAC ID: 3779724653 Enrollment ID: I20150814013502 |
| Provider Name | Susan Weber |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023349073 PECOS PAC ID: 1951432285 Enrollment ID: I20160128000020 |
| Provider Name | Cheryl Lynn White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164414561 PECOS PAC ID: 7214995216 Enrollment ID: I20160425001177 |
| Provider Name | Deborah Lynn Story |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093909145 PECOS PAC ID: 6103015318 Enrollment ID: I20170522001569 |
| Provider Name | Zahra Hussain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487176053 PECOS PAC ID: 7012283070 Enrollment ID: I20171019001891 |
| Provider Name | Christopher Lee Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871985564 PECOS PAC ID: 5698096360 Enrollment ID: I20171115002415 |
| Provider Name | Sharon B Stegall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447580816 PECOS PAC ID: 9133255300 Enrollment ID: I20180410000769 |
| Provider Name | Angela Skurat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720466246 PECOS PAC ID: 9436426822 Enrollment ID: I20181212001819 |
| Provider Name | Cynthia Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477514974 PECOS PAC ID: 7618869066 Enrollment ID: I20181217002989 |
| Provider Name | Erika N Geiggar-schad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639400740 PECOS PAC ID: 5890041735 Enrollment ID: I20190107000230 |
| Provider Name | Casey Lee Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225573249 PECOS PAC ID: 6204118029 Enrollment ID: I20190228000040 |
| Provider Name | Wilfredo Morges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871007377 PECOS PAC ID: 8729347257 Enrollment ID: I20190430000111 |
| Provider Name | Regina Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124298849 PECOS PAC ID: 5193895845 Enrollment ID: I20190509001991 |
| Provider Name | Kimberly Souza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902200645 PECOS PAC ID: 3072735703 Enrollment ID: I20190514000463 |
| Provider Name | Angela Marie Webb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942774500 PECOS PAC ID: 2668715178 Enrollment ID: I20190823002402 |
| Provider Name | Michael Hewett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467472480 PECOS PAC ID: 0244275014 Enrollment ID: I20190828004271 |
| Provider Name | Erika Updegrove |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811278575 PECOS PAC ID: 2769736768 Enrollment ID: I20200507001116 |
| Provider Name | Julie Lynne Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508990540 PECOS PAC ID: 5799915732 Enrollment ID: I20200730002627 |
| Provider Name | Sarah Lynn Blizzard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093073579 PECOS PAC ID: 1254565252 Enrollment ID: I20201203002368 |
| Provider Name | Chelsea Elizabeth Twiss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881172377 PECOS PAC ID: 3870996689 Enrollment ID: I20211004000873 |
| Provider Name | Tatum Siebert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528389566 PECOS PAC ID: 8527462886 Enrollment ID: I20211005002388 |
| Provider Name | Alicia Ottati |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174990972 PECOS PAC ID: 6204122187 Enrollment ID: I20220804000601 |
| Provider Name | Kathleen Tallent |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528238698 PECOS PAC ID: 5991874455 Enrollment ID: I20220808002887 |
| Provider Name | Eden Brown |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518087691 PECOS PAC ID: 0143591552 Enrollment ID: I20221013000698 |
| Provider Name | Ann M Hetzel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922327105 PECOS PAC ID: 8123336948 Enrollment ID: I20230111000417 |
| Provider Name | Lauren Mcmiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093374498 PECOS PAC ID: 2961737937 Enrollment ID: I20230127002797 |
| Provider Name | Timothy Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740346253 PECOS PAC ID: 7810218658 Enrollment ID: I20230525000060 |
| Provider Name | Tiffany Nickie-hull |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457503534 PECOS PAC ID: 7719268374 Enrollment ID: I20230731002951 |
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