Healthcare Provider Details

I. General information

NPI: 1275984130
Provider Name (Legal Business Name): EINSTEIN PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CEDAR LN SUITE 302
VIENNA VA
22182-5202
US

IV. Provider business mailing address

2235 CEDAR LN SUITE 302
VIENNA VA
22182-5202
US

V. Phone/Fax

Practice location:
  • Phone: 917-716-1854
  • Fax: 703-344-7309
Mailing address:
  • Phone: 917-716-1854
  • Fax: 703-344-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL MARTIN
Title or Position: AUTHORIZED REP/OWNER
Credential: MD
Phone: 917-716-1854