| Family Medicine Of Albemarle, Inc. | |
|
1450 Sachem Pl Suite 201 Charlottesville VA 22901-2554 | |
| (434) 973-9744 | |
| (434) 973-9790 |
| Full Name | Family Medicine Of Albemarle, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1450 Sachem Pl, Charlottesville, Virginia |
| Authorized Official Name and Position | Raymond Paul Marotta (PRESIDENT) |
| Authorized Official Contact | 4349739744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Of Albemarle, Inc. 1450 Sachem Pl Suite 201 Charlottesville VA 22901-2554 Ph: (434) 973-9744 | Family Medicine Of Albemarle, Inc. 1450 Sachem Pl Suite 201 Charlottesville VA 22901-2554 Ph: (434) 973-9744 |
| NPI Number | 1164429189 |
|---|---|
| Provider Enumeration Date | 07/05/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9931185444 |
|---|---|
| Medicare Enrollment ID | O20040625000630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164429189 | NPI | - | NPPES |
| 004580 | Other | VA | ANTHEM BLUE CROSS BLUE SH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Virginia) | Primary |
| Provider Name | Raymond Paul Marotta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871598995 PECOS PAC ID: 3072681055 Enrollment ID: I20100714000211 |
| Provider Name | Margaret H Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538646880 PECOS PAC ID: 0143573972 Enrollment ID: I20181025000056 |
| Provider Name | Krystyna Lee Portell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669954335 PECOS PAC ID: 4082958939 Enrollment ID: I20181203002929 |
| Provider Name | Stephanie Gillan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588143051 PECOS PAC ID: 6608117932 Enrollment ID: I20190412002189 |
| Provider Name | Katherine H Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437757093 PECOS PAC ID: 6204249717 Enrollment ID: I20201230000766 |
| Provider Name | Michelle Kensie Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336733062 PECOS PAC ID: 0042626335 Enrollment ID: I20210311000830 |
| Provider Name | Toni F Kistner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497376768 PECOS PAC ID: 8426465329 Enrollment ID: I20210319001611 |
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