Provider Demographics
NPI:1972672731
Name:LIFEWAY FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:LIFEWAY FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-496-4916
Mailing Address - Street 1:1821 OLD DONATION PKWY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3033
Mailing Address - Country:US
Mailing Address - Phone:757-496-4916
Mailing Address - Fax:757-496-4046
Practice Address - Street 1:1821 OLD DONATION PKWY
Practice Address - Street 2:SUITE #4
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3033
Practice Address - Country:US
Practice Address - Phone:757-496-4916
Practice Address - Fax:757-496-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205801719OtherMEDICARE NUMBER
VA080008247OtherMEDICARE NUMBER
VA1194806307OtherMEDICARE NUMBER