Healthcare Provider Details

I. General information

NPI: 1942651054
Provider Name (Legal Business Name): CHILDREN FIRST PEDIATRICS OF VIRGINIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FAIRY STREET EXT SUITE A
MARTINSVILLE VA
24112-1913
US

IV. Provider business mailing address

314 FAIRY STREET EXT SUITE A
MARTINSVILLE VA
24112-1913
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-5437
  • Fax: 276-666-6686
Mailing address:
  • Phone: 276-638-5437
  • Fax: 276-666-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101240119
License Number StateVA

VIII. Authorized Official

Name: DR. MARY ELIZABETH NOONAN
Title or Position: PEDIATRICIAN/OWNER
Credential: M.D.
Phone: 276-638-5437