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General NPI Number Information
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NPI Number | 1558428953
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Entity Type | Organization
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Legal Business Name | CENTURY PEDIATRICS INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 2024 OPITZ BLVD STE A
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3388
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Country | US
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Telephone | 703-492-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 22445 CONSERVANCY DR
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City | ASHBURN
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State | VA
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Zip | 20148-8068
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Country | US
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Telephone | 703-680-6641
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. SRIDEVI MADIRAJU
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Credential | OFFICE MANAGER
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Telephone | 571-334-6978
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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 | 0101054958
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License Number State | VA
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