MEDICARE: COLONIAL HEIGHTS PEDIATRICS LTD.

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		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972797256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL HEIGHTS PEDIATRICS LTD.

Provider Business Mailing Address
First Line	:	16011 KAIROS RD
Second Line	:	SUITE 'A'
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-520-2600
Fax Number	:	604-520-5853

Provider Business Practice Location Address
First Line	:	16011 KAIROS RD
Second Line	:	SUITE 'A'
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-520-2600
Fax Number	:	604-520-5853

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JAWED IQBAL
Credential	:	M.D.,
Telephone Number	:	804-520-2600

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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