Healthcare Provider Details

I. General information

NPI: 1427185784
Provider Name (Legal Business Name): VIRGO CARTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SPRING STREET SUITE 201
SILVER SPRING MD
20910-4030
US

IV. Provider business mailing address

1109 SPRING STREET SUITE 201
SILVER SPRING MD
20910-4030
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-3999
  • Fax: 301-576-6259
Mailing address:
  • Phone: 301-565-3999
  • Fax: 301-576-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD42811
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD43490
License Number StateMD

VIII. Authorized Official

Name: GABRIELLE N VIRGO
Title or Position: PRESIDENT
Credential: MD
Phone: 301-565-3999