NPI 1275896128

About Change

Organisation Exclusive Provider Organization Woodbridge, VA

Practice location

Address: 13662 Jefferson Davis Hwy, Woodbridge, VA 22191-2005
Phone: (919) 737-5600
Mailing address: 4833 Tommans Trl, Raleigh, NC 27616-0760

Authorised official

Name: Nelgy Olivio
Title: Ceo
Phone: (919) 737-5600

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Virginia →

Registry record

NPI: 1275896128
Entity type: Organization
NPI issued: 15 Jun 2012
Record last updated: 15 Jun 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.