Healthcare Provider Details

I. General information

NPI: 1225118532
Provider Name (Legal Business Name): PEDIATRIC PRIMARY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POCOSHOCK PL SUITE 302
RICHMOND VA
23235-6345
US

IV. Provider business mailing address

2500 POCOSHOCK PL SUITE 302
RICHMOND VA
23235-6345
US

V. Phone/Fax

Practice location:
  • Phone: 804-674-1985
  • Fax: 804-276-1048
Mailing address:
  • Phone: 804-674-1985
  • Fax: 804-276-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN LEWIS PILLSBURY DAVID
Title or Position: PRESIDENT
Credential: MD
Phone: 804-674-1985