Healthcare Provider Details

I. General information

NPI: 1780888776
Provider Name (Legal Business Name): NORTHERN VIRGINIA PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NO VIRGINIA AVENUE
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

107 NO VIRGINIA AVENUE
FALLS CHURCH VA
22046
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4446
  • Fax: 703-532-6970
Mailing address:
  • Phone: 703-532-4446
  • Fax: 703-532-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. PAMELA REAVES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 703-532-4446