| Reverent Medical Group Inc | |
|
623 Emancipation Hwy Ste 101 Fredericksburg VA 22401-4437 | |
| (800) 452-5574 | |
| (540) 940-6249 |
| Full Name | Reverent Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 623 Emancipation Hwy Ste 101, Fredericksburg, Virginia |
| Authorized Official Name and Position | Petros Ayele (CO OWNER) |
| Authorized Official Contact | 2028213040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reverent Medical Group Inc 623 Emancipation Hwy Ste 101 Fredericksburg VA 22401-4437 Ph: (800) 452-5574 | Reverent Medical Group Inc 623 Emancipation Hwy Ste 101 Fredericksburg VA 22401-4437 Ph: (800) 452-5574 |
| NPI Number | 1457861403 |
|---|---|
| Provider Enumeration Date | 10/04/2017 |
| Last Update Date | 10/12/2022 |
| Medicare PECOS PAC ID | 2466710827 |
|---|---|
| Medicare Enrollment ID | O20171213001948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457861403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Petros Ayele |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720238868 PECOS PAC ID: 9739228453 Enrollment ID: I20091209000125 |
| Provider Name | Donna Cyrus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285004572 PECOS PAC ID: 5294011821 Enrollment ID: I20170417000604 |
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