Lifephysician, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LIFEPHYSICIAN, LLC

Practice address

999 Waterside Dr Ste 2525
Norfolk, VA 23510-3316

Phone

(925) 824-3198

Fax

(949) 655-8602

NPI assigned

Aug 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amanda V. Chance, MD

Title

Owner

Phone

(646) 251-1992

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1194336313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 E LAKESHORE DR",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824822",
            "telephone_number": "646-251-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 WATERSIDE DR STE 2525",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235103316",
            "telephone_number": "925-824-3198",
            "fax_number": "949-655-8602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2010 Crow Canyon Pl Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945831344",
            "country_code": "US",
            "telephone_number": "925-824-3198",
            "fax_number": "949-655-8602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFEPHYSICIAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "CHANCE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-251-1992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Primary Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.