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General NPI Number Information
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NPI Number | 1093150468
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Entity Type | Organization
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Legal Business Name | COVINGTON PEDIATRICS, PLLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 411 W RIVERSIDE ST
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City | COVINGTON
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State | VA
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Zip | 24426-1273
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Country | US
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Telephone | 304-667-7332
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Fax |
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Provider Business Mailing Address
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Address Line | 411 W RIVERSIDE ST
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City | COVINGTON
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State | VA
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Zip | 24426-1273
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TIMOTHY J YORK
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Credential | DO
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Telephone | 304-667-7332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | S4522894
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License Number State | VA
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