Healthcare Provider Details

I. General information

NPI: 1093731689
Provider Name (Legal Business Name): KIDS CHOICE PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 COURTHOUSE RD SUITE A
SPOTSYLVANIA VA
22553-1798
US

IV. Provider business mailing address

10411 COURTHOUSE RD SUITE A
SPOTSYLVANIA VA
22553-1798
US

V. Phone/Fax

Practice location:
  • Phone: 540-710-6006
  • Fax: 540-710-6001
Mailing address:
  • Phone: 540-710-6006
  • Fax: 540-710-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101058461
License Number StateVA

VIII. Authorized Official

Name: RICHMAN SUZANNE
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 540-710-6006