| Tidewater Family Medical Care, Pc | |
|
516 Innovation Dr Ste 103 Chesapeake VA 23320-3847 | |
| (757) 495-0606 | |
| Not Available |
| Full Name | Tidewater Family Medical Care, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 516 Innovation Dr, Chesapeake, Virginia |
| Authorized Official Name and Position | Frank Joseph Piccioni (PRESIDENT) |
| Authorized Official Contact | 7574950606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Family Medical Care, Pc 516 Innovation Dr Ste. 103 Chesapeake VA 23320-3847 Ph: (757) 495-0606 | Tidewater Family Medical Care, Pc 516 Innovation Dr Ste 103 Chesapeake VA 23320-3847 Ph: (757) 495-0606 |
| NPI Number | 1730214248 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 07/14/2008 |
| Medicare PECOS PAC ID | 9436103306 |
|---|---|
| Medicare Enrollment ID | O20050502000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730214248 | NPI | - | NPPES |
| 10139414 | Medicaid | VA | |
| 131473 | Other | VA | OPTIMA ID |
| 172725 | Other | VA | ANTHEM BCBS ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0102037087 (Virginia) | Primary |
| Provider Name | Frank J Piccioni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528091634 PECOS PAC ID: 1951355833 Enrollment ID: I20050304000078 |
| Provider Name | Michelle M Paulsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689876823 PECOS PAC ID: 4789758764 Enrollment ID: I20080808000641 |
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