Healthcare Provider Details

I. General information

NPI: 1710072145
Provider Name (Legal Business Name): PEDIATRICS OF KEMPSVILLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 LAKE JAMES DR SUITE C
VIRGINIA BEACH VA
23464-6779
US

IV. Provider business mailing address

1212 LAKE JAMES DR SUITE C
VIRGINIA BEACH VA
23464-6779
US

V. Phone/Fax

Practice location:
  • Phone: 757-523-4589
  • Fax: 757-523-8920
Mailing address:
  • Phone: 757-523-4589
  • Fax: 757-523-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WINFIELD ANTHONY YOUNG
Title or Position: DIRECTOR
Credential: M.D.
Phone: 757-523-4589