Healthcare Provider Details

I. General information

NPI: 1114162476
Provider Name (Legal Business Name): PEDIATRICS AT THE HAMPTONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410B MARCELLA RD
HAMPTON VA
23666-2487
US

IV. Provider business mailing address

410 MARCELLA RD B
HAMPTON VA
23666-2487
US

V. Phone/Fax

Practice location:
  • Phone: 757-247-1111
  • Fax: 757-825-5740
Mailing address:
  • Phone: 757-247-1111
  • Fax: 757-825-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANGELA DENISE ODOM AUSTIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 757-247-1111