FAMILY MEDICINE OF LAKE RIDGE PC (NPI# 1417045816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417045816 |
| Entity Type | Organization |
| Organization Name | FAMILY MEDICINE OF LAKE RIDGE PC |
| Other Organization Name | FAMILY MEDICINE OF LAKE RIDGE |
| Practice Address |
3401 Commission Ct Ste 201 Woodbridge VA 22192 |
| Practice Telephone | 7034906265 |
| Practice Fax Number | 7034906713 |
| Mailing Telephone | 7034906265 |
| Mailing Fax Number | 7034906713 |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. GERRY A COPE (PHYSICIAN) |
| Authorized Official Telephone | 7034906265 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 0101039027 | VA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 0024057411 | VA | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 0101040586 | VA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Family Medicine of Lake Ridge | Other Name - Individual/Organization |
| Street Address |
3401 COMMISSION CT STE 201 |
| City | WOODBRIDGE |
| State | VA |
| Zip Code | 22192 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043219629 | Peter A Mendel | Family Medicine | 3401 Commission Ct, Suite 201, Woodbridge, VA 22192-1771 | 2005-07-18 |
| 1972700862 | Donna Goodin | Nurse Practitioner | 3401 Commission Ct, Ste 201, Woodbridge, VA 22192-1771 | 2007-07-02 |
| 1265648943 | Shadi Shareghi | Dentist | 3401 Commission Ct, Suite 202, Woodbridge, VA 22192-1771 | 2007-05-16 |
| 1760597157 | Robert G Java | Dentist | 3401 Commission Ct, Suite 202, Woodbridge, VA 22192 | 2006-08-19 |
| 1477552537 | Gerry A. Cope | Family Medicine | 3401 Commission Ct, Ste 201, Woodbridge, VA 22192-1771 | 2005-07-20 |
| 1043219025 | Peggy J Budnik | Family Medicine | 3401 Commission Ct, Ste 201, Woodbridge, VA 22192-1771 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245873645 | Ursula Jackson | Technician | 3500 Commission Ct, Woodbridge, VA 22192 | 2019-10-18 |
| 1205480779 | Ki Soo Park | Physical Therapy Assistant | 12825 Minnieville Road Suite 201, Lake Ridge, VA 22192 | 2019-08-01 |
| 1801448329 | Karen Lee Trivett | Specialist/Technologist, Other | 12584 Darby Brook Court, Woodbridge, VA 22192 | 2019-07-15 |
| 1407313166 | Nichele Amelia Thompson | Behavioral Analyst | 2731 Marblestone Dr, 101, Woodbridge, VA 22192 | 2019-02-28 |
| 1952877870 | Kimberly Ann Rojas Vazquez | Behavioral Analyst | 12531 Clipper Dr, Suite 203, Woodbridge, VA 22192 | 2018-10-18 |
| 1104391614 | Ykim Dental | Dentist | 2680 Optiz Blvd., Suite 120, Woodbridge, VA 22192 | 2018-10-11 |
| 1013418755 | Arm Transport | Non-emergency Medical Transport (VAN) | 13000 Harbor Center Dr Ste 132d, Woodbridge, VA 22192 | 2018-02-27 |
| 1811496813 | Francesca Nasi | Behavioral Analyst | 12531 Clipper Dr Ste 203, Woodbridge, VA 22192 | 2018-02-05 |
| 1942729504 | Bismark Transportation Service LLC | Non-emergency Medical Transport (VAN) | 12341 Woodlawn Court, Woodbridge, VA 22192 | 2017-09-14 |
| 1992226344 | Arm Baby Eldery Home Health LLC | Home Health | 13000 Harbor Center Dr # 312c, Woodbridge, VA 22192 | 2017-07-06 |
| Find all providers in zip 22192 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615168 | Well Health Medical Practice | Family Medicine | 676 Amboy Ave Ste 4, Woodbridge, NJ 07095-3144 | 2020-10-01 |
| 1700441326 | Cavery Health Clinic | Family Medicine | 14330 Gideon Dr Ste B, Woodbridge, VA 22192-4640 | 2019-05-08 |
| 1427411594 | Havya Dave | Family Medicine | 2280 Opitz Blvd Ste 250, Woodbridge, VA 22191-3362 | 2016-04-05 |
| 1548634678 | Family Medical Center Holding LLC | Family Medicine | 14904 Jefferson Davis Hwy Ste 205, Woodbridge, VA 22191-3908 | 2015-12-01 |
| 1932549128 | Matthew Richard Kereliuk | Family Medicine | 205 Marycroft Ave., Woodbridge, ONTARIO L4L 5X8 | 2013-07-02 |
| 1760798797 | Naresh J. Patel | Family Medicine | 118 Roanoke St, Woodbridge, NJ 07095-2549 | 2010-08-27 |
| 1003058538 | Zahir Zoe Jimenez-tosado | Family Medicine | 4379 Ridgewood Center Drive, #102, Woodbridge, VA 22192-8322 | 2009-03-30 |
| 1487817466 | Chantal D Lewis | Family Medicine | 3122 Golansky Blvd Ste 101, Woodbridge, VA 22192-4267 | 2008-07-09 |
| 1740443183 | Millenium Medical Corp | Family Medicine | 13168 Centerpointe Way Ste 101, Woodbridge, VA 22193-5287 | 2008-07-07 |
| 1376700500 | Christina Bauer | Family Medicine | 12480 Dillingham Sq, Woodbridge, VA 22192-5258 | 2008-05-16 |
| Find all providers in WOODBRIDGE | ||||
| City | WOODBRIDGE |
| Zip Code | 22192 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.