Healthcare Provider Details

I. General information

NPI: 1275954349
Provider Name (Legal Business Name): COLONIAL HEIGHTS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16011 KAIROS RD SUITE 100
SOUTH CHESTERFIELD VA
23834-5207
US

IV. Provider business mailing address

16011 KAIROS RD SUITE 100
SOUTH CHESTERFIELD VA
23834-5207
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-2600
  • Fax: 804-520-5853
Mailing address:
  • Phone: 804-520-2600
  • Fax: 804-520-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number010156547
License Number StateVA

VIII. Authorized Official

Name: DR. JAWED IQBAL
Title or Position: DIRECTOR
Credential: M.D
Phone: 804-536-1332