Healthcare Provider Details

I. General information

NPI: 1245358621
Provider Name (Legal Business Name): CHILDREN'S PULMONARY & SLEEP SERVICES, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 E PARHAM RD SUITE - 200
RICHMOND VA
23228-2235
US

IV. Provider business mailing address

PO BOX 28596
RICHMOND VA
23228-8596
US

V. Phone/Fax

Practice location:
  • Phone: 804-266-7733
  • Fax: 804-266-7736
Mailing address:
  • Phone: 804-266-7733
  • Fax: 804-266-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101238511
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0101238511
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0101238511
License Number StateVA

VIII. Authorized Official

Name: DR. NAIM S. BASHIR
Title or Position: PRESIDENT
Credential:
Phone: 804-266-7733