Healthcare Provider Details

I. General information

NPI: 1144318791
Provider Name (Legal Business Name): GLOUCESTER PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7574 HOSPITAL DR.
GLOUCESTER VA
23061-0700
US

IV. Provider business mailing address

PO BOX 700 7574 HOSPITAL DR.
GLOUCESTER VA
23061-0700
US

V. Phone/Fax

Practice location:
  • Phone: 804-694-0011
  • Fax: 804-693-0355
Mailing address:
  • Phone: 804-694-0011
  • Fax: 804-693-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BARBARA ANNE ALLISON-BRYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-694-0011