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General NPI Number Information
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NPI Number | 1386652824
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL GROUP, INC., D/B/A LIBERTY PEDIATRICS
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 12705 MCMANUS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4459
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Country | US
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Telephone | 757-668-4800
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Fax | 757-668-4828
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Provider Business Mailing Address
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Address Line | 606 DENBIGH BLVD SUITE 400
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-4413
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Country | US
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Telephone | 757-833-0780
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Fax | 757-833-0783
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Authorized Official
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Title or Position | SENIOR VP/CFO
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Name | KATHRYN J ABSHIRE
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Credential |
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Telephone | 757-668-8565
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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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