Healthcare Provider Details

I. General information

NPI: 1699863498
Provider Name (Legal Business Name): SPRINGFIELD PEDIATRIC ASSOCIATES, LTD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 301
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

8348 TRAFORD LN SUITE 301
SPRINGFIELD VA
22152-1663
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-5200
  • Fax: 703-451-0044
Mailing address:
  • Phone: 703-451-5200
  • Fax: 703-451-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DOBE (DEBORAH) MAYERGOYZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-451-5200