Provider Demographics
NPI:1144390626
Name:FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-934-3434
Mailing Address - Street 1:2050 HILLPOINT BLVD N
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7181
Mailing Address - Country:US
Mailing Address - Phone:757-934-3434
Mailing Address - Fax:757-538-9038
Practice Address - Street 1:2050 HILLPOINT BLVD N
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7181
Practice Address - Country:US
Practice Address - Phone:757-934-3434
Practice Address - Fax:757-538-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005602785Medicaid
VA005647371Medicaid
VA005693811Medicaid
VA005623260Medicaid
VA005651131Medicaid
VA010025711Medicaid
VA005623260Medicaid
VAH22238Medicare UPIN
VAC01170Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
VAE16303Medicare UPIN
VAH90457Medicare UPIN
VA005651131Medicaid
VA005602785Medicaid