Healthcare Provider Details

I. General information

NPI: 1164527701
Provider Name (Legal Business Name): CHILDREN'S HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 HEATHERSTONE DR
FREDERICKSBURG VA
22407-4828
US

IV. Provider business mailing address

1139 HEATHERSTONE DR
FREDERICKSBURG VA
22407-4828
US

V. Phone/Fax

Practice location:
  • Phone: 540-785-9595
  • Fax: 540-785-9870
Mailing address:
  • Phone: 540-785-9595
  • Fax: 540-785-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101231012
License Number StateVA

VIII. Authorized Official

Name: DR. LYNN CAO
Title or Position: MD
Credential: MD
Phone: 540-785-9595