| Mednovations Llc | |
|
1712 Financial Loop Woodbridge VA 22192-2459 | |
| (571) 989-4134 | |
| Not Available |
| Full Name | Mednovations Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1712 Financial Loop, Woodbridge, Virginia |
| Authorized Official Name and Position | Chantal D Lewis (OWNER) |
| Authorized Official Contact | 3012549444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mednovations Llc 13010 Smoketown Rd Woodbridge VA 22192-3367 Ph: (301) 254-9444 | Mednovations Llc 1712 Financial Loop Woodbridge VA 22192-2459 Ph: (571) 989-4134 |
| NPI Number | 1013402593 |
|---|---|
| Provider Enumeration Date | 06/26/2018 |
| Last Update Date | 06/26/2018 |
| Medicare PECOS PAC ID | 8426308628 |
|---|---|
| Medicare Enrollment ID | O20180910002376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013402593 | NPI | - | NPPES |
| 1487817466 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Carlos K Fagbenro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447528328 PECOS PAC ID: 8729249388 Enrollment ID: I20130426000005 |
| Provider Name | Chantal D Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487817466 PECOS PAC ID: 6305982455 Enrollment ID: I20161207000891 |
| Provider Name | Rajni Sharma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376011346 PECOS PAC ID: 7810230836 Enrollment ID: I20190618000626 |
| Provider Name | Olguine Theard-chery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811518962 PECOS PAC ID: 2860811080 Enrollment ID: I20201007001306 |
| Provider Name | Amen C Otunba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043914245 PECOS PAC ID: 1456718626 Enrollment ID: I20230601003157 |
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