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Organization

LEGACY CARE ACO LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRACI LOPEZ (DIRECTOR REVENUE CYCLE)
(757) 536-2411
Entity
Organization

Contact information

Practice address
780 LYNNHAVEN PKWY STE 400, VIRGINIA BCH, VA 23452-7332
(757) 536-2246
Mailing address
PO BOX 830063, PHILADELPHIA, PA 19182-0063
(757) 536-2246

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207QG0300X
Geriatric Medicine (Family Medicine) Physician
207R00000X
Internal Medicine Physician
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
363L00000X
Nurse Practitioner

Other

Enumeration date
06/15/2023
Last updated
03/20/2026
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