Healthcare Provider Details

I. General information

NPI: 1104994623
Provider Name (Legal Business Name): PEDIATRICARE OF NORTHERN VIRGINIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 SUDLEY RD SUITE 306
MANASSAS VA
20110-4420
US

IV. Provider business mailing address

8640 SUDLEY ROAD SUITE 306
MANASSAS VA
20110-4404
US

V. Phone/Fax

Practice location:
  • Phone: 703-330-3939
  • Fax: 703-331-0959
Mailing address:
  • Phone: 703-330-3939
  • Fax: 703-331-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANK JAMES GIANCOLA
Title or Position: PRESIDENT
Credential: MD
Phone: 703-330-3939