Healthcare Provider Details

I. General information

NPI: 1962616813
Provider Name (Legal Business Name): KIDZ DOCS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/22/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N WASHINGTON STREET
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

675 N WASHINGTON STREET
ALEXANDRIA VA
22314
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-6093
  • Fax:
Mailing address:
  • Phone: 703-765-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101041481
License Number StateVA

VIII. Authorized Official

Name: MR. PATRICK KELLY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-765-6093