Healthcare Provider Details

I. General information

NPI: 1114091931
Provider Name (Legal Business Name): UNION MILL PEDIATRICS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 BRADDOCK RD. STE 201
CENTREVILLE VA
20121
US

IV. Provider business mailing address

13880 BRADDOCK RD. STE 201
CENTREVILLE VA
20121
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-6304
  • Fax: 703-802-6307
Mailing address:
  • Phone: 703-802-6304
  • Fax: 703-802-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. WAYNE RICHARD ERIKSSON
Title or Position: BUSINESS OWNER
Credential: MD
Phone: 703-802-6304