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General NPI Number Information
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NPI Number | 1528103645
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Entity Type | Organization
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Legal Business Name | STEVENSON PEDIATRICS
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6000 STEVENSON AVE STE 104
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3577
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Country | US
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Telephone | 703-823-2400
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Fax | 703-823-2013
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Provider Business Mailing Address
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Address Line | 6000 STEVENSON AVE STE 104
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3577
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Country | US
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Telephone | 703-823-2400
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Fax | 703-823-2013
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Authorized Official
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Title or Position | MD
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Name | ROSARIO G DANCEL
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Credential |
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Telephone | 703-823-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 0101032546
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License Number State | VA
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