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General NPI Number Information
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NPI Number | 1710928437
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC GROUP, PC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7015C MANCHESTER BLVD
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3253
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Country | US
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Telephone | 703-971-6900
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Fax | 703-971-9184
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Provider Business Mailing Address
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Address Line | 7015C MANCHESTER BLVD
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3253
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Country | US
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Telephone | 703-971-6900
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Fax | 703-971-9184
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PATRICIA RIVERS
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Credential |
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Telephone | 703-971-6900
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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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