Healthcare Provider Details

I. General information

NPI: 1033224340
Provider Name (Legal Business Name): NOVA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 OLD BRIDGE RD SUITE 201
WOODBRIDGE VA
22192-2738
US

IV. Provider business mailing address

6120 BRANDON AVE SUITE 308
SPRINGFIELD VA
22150-2522
US

V. Phone/Fax

Practice location:
  • Phone: 703-491-2141
  • Fax: 703-690-0815
Mailing address:
  • Phone: 703-451-3333
  • Fax: 703-451-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAURENCE SEIDMAN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 703-451-3333