Organization
LIFETIME FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA BELBEN SHUPE MD (OWNER)
(703) 754-0425
Entity
Organization
Contact information
Practice address
14535 JOHN MARSHALL HWY, SUITE 105, GAINESVILLE, VA 20155-4023
(703) 754-0425
(703) 754-2888
Mailing address
14535 JOHN MARSHALL HWY, SUITE 105, GAINESVILLE, VA 20155-4023
(703) 754-0425
(703) 754-2888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101058775
VA
Other
Enumeration date
10/04/2006
Last updated
07/08/2011
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