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General NPI Number Information
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NPI Number | 1295044774
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Entity Type | Organization
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Legal Business Name | PORTSMOUTH PEDIATRICS, PC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 446 EFFINGHAM ST. STE 302
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City | PORTSMOUTH
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State | VA
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Zip | 23704
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Country | US
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Telephone | 757-673-6277
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Fax | 757-673-6411
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Provider Business Mailing Address
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Address Line | 446 EFFINGHAM ST. STE. 302
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City | PORTSMOUTH
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State | VA
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Zip | 23704
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Country | US
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Telephone | 757-673-6277
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Fax | 757-673-6411
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA A. DELACRUZ
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Credential |
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Telephone | 757-673-6277
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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 |
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License Number State |
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