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General NPI Number Information
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NPI Number | 1457381766
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PARTNERS OF STAFFORD PC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 110 SOARING EAGLE DRIVE
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City | STAFFORD
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State | VA
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Zip | 22556
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Country | US
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Telephone | 540-720-2126
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Fax | 540-720-1002
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Provider Business Mailing Address
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Address Line | 110 SOARING EAGLE DRIVE
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City | STAFFORD
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State | VA
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Zip | 22556
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Country | US
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Telephone | 540-720-2126
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Fax | 540-720-1002
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Authorized Official
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Title or Position | PHYSICIAN
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Name | TAMARA LOVING
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Credential | M.D.
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Telephone | 540-720-2126
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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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