MEDICARE: NORFOLK PEDIATRICS, P.L.C.

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	261QP2300X	Primary Care Clinic/Center	2695	VA

General Provider Information

NPI Number	:	1760413298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK PEDIATRICS, P.L.C.

Provider Business Mailing Address
First Line	:	1529 INTERNATIONAL BLVD
Second Line	:	SUITE 103
City	:	NORFOLK
State	:	VA
Zip	:	23513-4802
Country	:	US
Telephone Number	:	757-855-6800
Fax Number	:	757-855-7771

Provider Business Practice Location Address
First Line	:	1529 INTERNATIONAL BLVD
Second Line	:	SUITE 103
City	:	NORFOLK
State	:	VA
Zip	:	23513-4802
Country	:	US
Telephone Number	:	757-855-6800
Fax Number	:	757-855-7771

Authorized Official
Title or Position	:	DOCTORS
Name	:	DR. SANJAY M AMIN
Credential	:	M.D.
Telephone Number	:	757-855-6800

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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