Healthcare Provider Details
I. General information
NPI: 1255358065
Provider Name (Legal Business Name): PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/16/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
10571 TELEGRAPH ROAD SUITE 110
GLEN ALLEN VA
23059
US
IV. Provider business mailing address
10571 TELEGRAPH ROAD SUITE 110
GLEN ALLEN VA
23059
US
V. Phone/Fax
- Phone: 804-266-9616
- Fax: 804-461-4935
- Phone: 804-266-9616
- Fax: 804-461-4935
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
LIV
G
SCHNEIDER
Title or Position: PRESIDENT
Credential: MD
Phone: 804-266-9616