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General NPI Number Information
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NPI Number | 1235347857
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Entity Type | Organization
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Legal Business Name | ROCKBRIDGE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 110 HOUSTON ST SUITE B
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City | LEXINGTON
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State | VA
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Zip | 24450-2437
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Country | US
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Telephone | 540-463-2201
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Fax | 540-463-2218
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Provider Business Mailing Address
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Address Line | 110 HOUSTON ST SUITE B
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City | LEXINGTON
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State | VA
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Zip | 24450-2437
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Country | US
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Telephone | 540-463-2201
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Fax | 540-463-2218
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL B. STILLWELL
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Credential |
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Telephone | 540-463-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101238218
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License Number State | VA
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