Healthcare Provider Details

I. General information

NPI: 1598096091
Provider Name (Legal Business Name): PRINCE WILLIAM PEDIATRIC CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 STONEWALL RD UNIT 1A
MANASSAS VA
20110-8326
US

IV. Provider business mailing address

8701 STONEWALL RD UNIT 1A
MANASSAS VA
20110-8326
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-9878
  • Fax: 703-257-9772
Mailing address:
  • Phone: 703-257-9878
  • Fax: 703-257-9772

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. SHEIKH M HOSSAIN
Title or Position: PRESIDENT
Credential: M.D.,FAAP
Phone: 703-257-9878