Healthcare Provider Details

I. General information

NPI: 1093952277
Provider Name (Legal Business Name): WHOLE CHILD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLZ SUTIE #340
ASHBURN VA
20147-3403
US

IV. Provider business mailing address

20925 PROFESSIONAL PLZ SUTIE #340
ASHBURN VA
20147-3403
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-8900
  • Fax:
Mailing address:
  • Phone: 703-723-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN SOKOLOW
Title or Position: PRESIDENT
Credential:
Phone: 703-723-8900