Provider Demographics
NPI:1730618091
Name:WELL CLINIC PEDIATRICS & FAMILY MEDICINE PC
Entity type:Organization
Organization Name:WELL CLINIC PEDIATRICS & FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:LOPITO
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUGARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-0588
Mailing Address - Street 1:200 MEDICAL PKWY STE 315
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-0588
Mailing Address - Fax:757-548-8572
Practice Address - Street 1:200 MEDICAL PARKWAY SUITE 315
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-0588
Practice Address - Fax:757-548-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222102261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190000714OtherMEDICARE PIN
VAH04227OtherMEDICARE UPIN
VA190000714OtherMEDICARE OSCAR/CERTIFICATION
VA005605423Medicaid