=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689938649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORT WARWICK PEDIATRICS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2012
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11803 JEFFERSON AVE STE 236
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-873-8883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11803 JEFFERSON AVE SUITE236
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-873-8883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. H. CHRISTOPHER LIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 757-876-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------