Provider Demographics
NPI:1629263199
Name:MID-ATLANTIC FAMILY MEDICINE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ASUNCION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-705-5265
Mailing Address - Street 1:828 HEALTHY WAY
Mailing Address - Street 2:STE 350
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7958
Mailing Address - Country:US
Mailing Address - Phone:757-552-0472
Mailing Address - Fax:757-552-0472
Practice Address - Street 1:828 HEALTHY WAY
Practice Address - Street 2:STE 350
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7958
Practice Address - Country:US
Practice Address - Phone:757-705-5265
Practice Address - Fax:757-962-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty