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General NPI Number Information
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NPI Number | 1447519715
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Entity Type | Organization
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Legal Business Name | CHILDREN & ADOLESCENT PEDIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 161 FORT EVANS RD NE SUITE 330
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City | LEESBURG
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State | VA
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Zip | 20176-3369
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Country | US
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Telephone | 703-777-5224
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Fax | 703-777-5227
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Provider Business Mailing Address
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Address Line | 161 FORT EVANS RD NE SUITE 330
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City | LEESBURG
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State | VA
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Zip | 20176-3369
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Country | US
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Telephone | 703-777-5224
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Fax | 703-777-5227
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Authorized Official
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Title or Position | OWNER
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Name | SOSUN FAQIRI
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Credential | MD
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Telephone | 302-299-6648
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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 | 10101251326
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License Number State | VA
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