Healthcare Provider Details

I. General information

NPI: 1205928587
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST FL 1
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

PO BOX 100445
ATLANTA GA
30384-0445
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8000
  • Fax: 954-851-1948
Mailing address:
  • Phone: 954-384-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS E. GLASER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 954-384-0175