Healthcare Provider Details

I. General information

NPI: 1841997822
Provider Name (Legal Business Name): PEDIATRIC PARTNERS OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 STANDING RIDGE DR
POWHATAN VA
23139-8051
US

IV. Provider business mailing address

P.O. BOX 76354
NORTH CHESTERFIELD VA
23235-4735
US

V. Phone/Fax

Practice location:
  • Phone: 804-464-2018
  • Fax: 804-464-2535
Mailing address:
  • Phone: 804-464-2018
  • Fax: 804-464-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMANTHA SEMEJA
Title or Position: CORPORATE OPERATIONS MGR
Credential:
Phone: 804-464-2018