1164574950 NPI number — PEDIATRIC HEALTH PARTNERS,PLLC

Table of content: (NPI 1164574950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164574950 NPI number — PEDIATRIC HEALTH PARTNERS,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC HEALTH PARTNERS,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164574950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3701 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-966-9873
Provider Business Mailing Address Fax Number:
757-967-9547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23707-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-966-9873
Provider Business Practice Location Address Fax Number:
757-967-9547
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLORIA
Authorized Official First Name:
PERLA
Authorized Official Middle Name:
JAMIAS
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
757-966-9873

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0101035962 & 0101046 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2127819 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2461504 & 2696905 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 75160 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2696905 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010057361 & 01005733 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5514567 & 5514570 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 137078 & 137133 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3652536 & 3652579 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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