Healthcare Provider Details

I. General information

NPI: 1972797256
Provider Name (Legal Business Name): COLONIAL HEIGHTS PEDIATRICS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16011 KAIROS RD SUITE 'A'
COLONIAL HEIGHTS VA
23834-5205
US

IV. Provider business mailing address

16011 KAIROS RD SUITE 'A'
COLONIAL HEIGHTS VA
23834-5205
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-2600
  • Fax: 604-520-5853
Mailing address:
  • Phone: 804-520-2600
  • Fax: 604-520-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAWED IQBAL
Title or Position: DIRECTOR
Credential: M.D.,
Phone: 804-520-2600