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General NPI Number Information
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NPI Number | 1649666728
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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 | 04/15/2015
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 385 GARRISONVILLE RD
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City | STAFFORD
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State | VA
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Zip | 22554-1545
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Country | US
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Telephone | 540-288-1551
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Fax | 540-288-8387
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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 | 703-899-7593
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Fax | 540-288-8387
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISHNA P MADIRAJU
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Credential | M.D
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Telephone | 703-899-7593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110004905
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License Number State | VA
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