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General NPI Number Information
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NPI Number | 1447387865
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Entity Type | Organization
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Legal Business Name | PENINSULA PEDIATRICS LTD
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11835 FISHING POINT DR STE 207
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2585
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Country | US
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Telephone | 757-875-3334
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Fax | 757-873-1128
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Provider Business Mailing Address
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Address Line | 11835 FISHING POINT DR STE 207
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2585
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Country | US
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Telephone | 757-875-3334
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Fax | 757-873-1128
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Authorized Official
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Title or Position | PARTNER SECRETARY
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Name | MR. BRIAN K BUTCHER
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Credential | MD
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Telephone | 757-873-3334
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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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