# LIFETIME FAMILY MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134214356
- **Authorized official:** DR. THERESA BELBEN SHUPE MD (OWNER)
- **Authorized official phone:** (703) 754-0425

## Contact information

- **Practice address:** 14535 JOHN MARSHALL HWY, SUITE 105, GAINESVILLE, VA 20155-4023
- **Practice address phone:** (703) 754-0425
- **Practice address fax:** (703) 754-2888
- **Mailing address:** 14535 JOHN MARSHALL HWY, SUITE 105, GAINESVILLE, VA 20155-4023
- **Mailing address phone:** (703) 754-0425
- **Mailing address fax:** (703) 754-2888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101058775 | VA | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 07/08/2011