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163 Fort Evans Road Ne Leesburg VA 20176-4420 | |
| (703) 443-2000 | |
| (703) 443-2033 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 163 Fort Evans Road Ne, Leesburg, Virginia |
| Authorized Official Name and Position | Amandeep Dhindsa (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7038404707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
163 Fort Evans Road, Ne Leesburg VA 20176-4420 Ph: (703) 840-4707 | 163 Fort Evans Road Ne Leesburg VA 20176-4420 Ph: (703) 443-2000 |
| NPI Number | 1629109806 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 09/04/2024 |
| Medicare PECOS PAC ID | 5193822930 |
|---|---|
| Medicare Enrollment ID | O20070514000106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629109806 | NPI | - | NPPES |
| 1629109806 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Virginia) | Primary |
| 261QR0206X | Clinic/center - Radiology, Mammography | (* (Not Available)) | Secondary |
| Provider Name | Rhonda Stewart |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346262532 PECOS PAC ID: 1254319098 Enrollment ID: I20040709000117 |
| Provider Name | Megan E Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619014206 PECOS PAC ID: 1052483641 Enrollment ID: I20080626000046 |
| Provider Name | Valerie C Williamson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598750143 PECOS PAC ID: 5698828978 Enrollment ID: I20090804000497 |
| Provider Name | Lubna Rana |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023133469 PECOS PAC ID: 2466553789 Enrollment ID: I20100726000747 |
| Provider Name | Jennifer Martin Hickman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467581504 PECOS PAC ID: 5597831602 Enrollment ID: I20110906000413 |
| Provider Name | Gwen Elizabeth Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508207135 PECOS PAC ID: 5294962676 Enrollment ID: I20131210000707 |
| Provider Name | Glen Edgar Tomkins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366722126 PECOS PAC ID: 8224265400 Enrollment ID: I20131213001055 |
| Provider Name | Stephanie N Puloka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255537023 PECOS PAC ID: 5496930406 Enrollment ID: I20151228001928 |
| Provider Name | Byron O Whyte |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720255649 PECOS PAC ID: 3577785492 Enrollment ID: I20160107002383 |
| Provider Name | Cornelia Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568637999 PECOS PAC ID: 4688976350 Enrollment ID: I20160504001972 |
| Provider Name | Marsabeth Amhayes Floyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710145339 PECOS PAC ID: 7012209059 Enrollment ID: I20160725000467 |
| Provider Name | Tonya M Adkins |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285721712 PECOS PAC ID: 4082851936 Enrollment ID: I20161219000732 |
| Provider Name | Meagan Hawley Ulrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407409188 PECOS PAC ID: 0941531107 Enrollment ID: I20191019000015 |
| Provider Name | Lisa V Jackson-wardlaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427404599 PECOS PAC ID: 3173956240 Enrollment ID: I20191203001636 |
| Provider Name | Katherine M Kruse |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285807719 PECOS PAC ID: 0446667265 Enrollment ID: I20210323002116 |
| Provider Name | Kathleen Bowie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033736525 PECOS PAC ID: 1355758095 Enrollment ID: I20210325002344 |
| Provider Name | Aditi Dholakia |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1023562394 PECOS PAC ID: 2466740444 Enrollment ID: I20210604000538 |
| Provider Name | Adrianne Jones Gruner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023777273 PECOS PAC ID: 1153718101 Enrollment ID: I20220421002780 |
| Provider Name | Carrie Khanyisa Sartor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750919288 PECOS PAC ID: 0446673529 Enrollment ID: I20240930000965 |
| Provider Name | Carolyn Louise Garcia |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871571349 PECOS PAC ID: 4082799028 Enrollment ID: I20241101001705 |
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