| NPI | 1568162808 |
|---|---|
| Former Legal Business Name | CENTERWELL SENIOR PRIMARY CARE VA PC |
| Doing Business As | CENTERWELL SENIOR PRIMARY CARE-TIDEWATER |
| Entity Type | Organization |
| Authorized Contact | ANGIE MARTINEZ Senior Credentialing Professional 407-447-7120 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2024-03-11 |