MEDICARE: CHILDRENS MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1649325242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	601 CHILDRENS LN
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1910
Country	:	US
Telephone Number	:	757-668-7017
Fax Number	:	757-668-8929

Provider Business Practice Location Address
First Line	:	4505 COLUMBUS ST STE 250
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5011
Country	:	US
Telephone Number	:	757-499-7442
Fax Number	:	757-490-3638

Authorized Official
Title or Position	:	SENIOR VP/CFO
Name	:	KATHRYN J ABSHIRE
Credential	:
Telephone Number	:	757-668-8565

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/26/2024

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