Healthcare Provider Details

I. General information

NPI: 1457373425
Provider Name (Legal Business Name): CAROLINE PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17470 CENTER DR STE 4A
RUTHER GLEN VA
22546-2881
US

IV. Provider business mailing address

17470 CENTER DR STE 4A
RUTHER GLEN VA
22546-2881
US

V. Phone/Fax

Practice location:
  • Phone: 804-448-5445
  • Fax: 804-448-8776
Mailing address:
  • Phone: 804-448-5445
  • Fax: 804-448-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. REBECCA S SIMES
Title or Position: OWNER OF PRACTICE
Credential: MD
Phone: 804-448-5445