Healthcare Provider Details

I. General information

NPI: 1144468836
Provider Name (Legal Business Name): CHILDRENS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 COMMERCIAL LN GODWIN BLDG ON RT. 10, SUITE 220
SUFFOLK VA
23434-8149
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-2600
  • Fax:
Mailing address:
  • Phone: 757-668-7017
  • Fax: 757-668-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHRYN J ABSHIRE
Title or Position: SENIOR VP/CFO
Credential:
Phone: 757-668-8565