Healthcare Provider Details

I. General information

NPI: 1972711760
Provider Name (Legal Business Name): VIRGINIA PEDIATRIC & ADOLESCENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 TRAFORD LN
SPRINGFIELD VA
22152-1654
US

IV. Provider business mailing address

8316 TRAFORD LN
SPRINGFIELD VA
22152-1654
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8400
  • Fax: 703-569-1182
Mailing address:
  • Phone: 703-569-8400
  • Fax: 703-569-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RICK CHRISTENSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-569-8400