Medsource, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

0101051020 Issued in VA

Legal business name

MEDSOURCE, LLC

Practice address

3909 Midlands Road,
Suite: B
Williamsburg, VA 23188

Phone

(757) 220-5051

Fax

(757) 220-5053

NPI assigned

Aug 21, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Ray Joseph Gagne, EET

Title

Partner

Phone

(757) 220-5051

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250812800000",
    "number": "1487886537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 MIDLANDS ROAD,",
            "address_2": "SUITE: B",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "23188",
            "telephone_number": "757-220-5051",
            "fax_number": "757-220-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 MIDLANDS ROAD,",
            "address_2": "SUITE: B",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "23188",
            "telephone_number": "757-220-5051",
            "fax_number": "757-220-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-21",
        "last_updated": "2009-08-21",
        "status": "A",
        "authorized_official_last_name": "GAGNE",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "757-220-5051",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EET"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101051020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth-Ann Griesser McSweeney, M.ED, CCC-SLP
• Celeste A McVeigh, LCSW
• Kristi Kyllonen McVey, PT
• Kevin Michael McWilliams, PH.D.
• Jhana Medlin
• Neha Mehta
• Melissa Redd, LCSW PLLC
• Emily Mellman
• Joann Blair Mello, FNP-BC
• Kathleen U Mendoza, NP

• Specialist in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2009; 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.