Healthcare Provider Details

I. General information

NPI: 1619906286
Provider Name (Legal Business Name): FALL HILL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 FALL HILL AVE SUITE 290
FREDERICKSBURG VA
22401-3342
US

IV. Provider business mailing address

2300 FALL HILL AVE SUITE 290
FREDERICKSBURG VA
22401-3342
US

V. Phone/Fax

Practice location:
  • Phone: 540-899-2555
  • Fax: 540-899-3554
Mailing address:
  • Phone: 540-899-2555
  • Fax: 540-899-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237777
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101049316
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101230344
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101235168
License Number StateVA

VIII. Authorized Official

Name: CLAUDIA SUSSDORF
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 540-899-2555