Healthcare Provider Details

I. General information

NPI: 1114295110
Provider Name (Legal Business Name): ROYAL OAK PEDIATRIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RADIO HILL RD
MARION VA
24354-4224
US

IV. Provider business mailing address

590 RADIO HILL RD
MARION VA
24354-4224
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8183
  • Fax: 276-783-9267
Mailing address:
  • Phone: 276-783-8183
  • Fax: 276-783-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANITA HENLEY
Title or Position: OWNER
Credential: DO
Phone: 276-783-8183