Healthcare Provider Details

I. General information

NPI: 1073403861
Provider Name (Legal Business Name): LIGHTHOUSE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUHI G. RAIZADA
Title or Position: DOCTOR
Credential: MD
Phone: 973-572-8892