Healthcare Provider Details

I. General information

NPI: 1437401015
Provider Name (Legal Business Name): WARD'S CORNER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 06/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7423 GRANBY ST
NORFOLK VA
23505-3406
US

IV. Provider business mailing address

7423 GRANBY ST
NORFOLK VA
23505-3406
US

V. Phone/Fax

Practice location:
  • Phone: 757-451-5000
  • Fax:
Mailing address:
  • Phone: 757-451-5000
  • Fax: 757-451-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. AMANDA EARLENE AVILA
Title or Position: OWNER
Credential:
Phone: 757-779-1955