1710928437 NPI number — THE PEDIATRIC GROUP, PC

Table of content: (NPI 1710928437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710928437 NPI number — THE PEDIATRIC GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PEDIATRIC GROUP, PC
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:
1710928437
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:
7015C MANCHESTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22310-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-971-6900
Provider Business Mailing Address Fax Number:
703-971-9184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015C MANCHESTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22310-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-971-6900
Provider Business Practice Location Address Fax Number:
703-971-9184
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERS
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
703-971-6900

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1407814403 . This is a "T. GARRETT, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1700844701 . This is a "A. KAPOOR, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427016864 . This is a "V. GIANNUZZI, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205884434 . This is a "E. LIN, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255399382 . This is a "N. LEYKAM, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225096373 . This is a "E. CAVROS, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1689632028 . This is a "C. FUGATE, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1235187725 . This is a "E. PALUMBO, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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