=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780888776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN VIRGINIA PEDIATRICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 NO VIRGINIA AVENUE
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-532-4446
-----------------------------------------------------
Fax | 703-532-6970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 NO VIRGINIA AVENUE
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-532-4446
-----------------------------------------------------
Fax | 703-532-6970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. PAMELA REAVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-532-4446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------