Healthcare Provider Details

I. General information

NPI: 1376928234
Provider Name (Legal Business Name): COUNTY PEDIATRICS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HARPERS ML
WILLIAMSBURG VA
23185-7521
US

IV. Provider business mailing address

6420 GEORGE WASHINGTON MEM HWY STE B
YORKTOWN VA
23692-2180
US

V. Phone/Fax

Practice location:
  • Phone: 757-903-5074
  • Fax:
Mailing address:
  • Phone: 757-969-6544
  • Fax: 757-969-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101246193
License Number StateVA

VIII. Authorized Official

Name: DR. BINA A FENN
Title or Position: PROVIDER
Credential: M.D.
Phone: 757-969-6544