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General NPI Number Information
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NPI Number | 1790722130
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRICS, LLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 2300 CHARLES ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3346
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Country | US
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Telephone | 540-373-2228
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Fax | 540-373-7008
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Provider Business Mailing Address
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Address Line | 2300 CHARLES ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3346
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Country | US
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Telephone | 540-373-2228
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Fax | 540-373-7008
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ANNE BRADSHAW
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Credential | M.D.
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Telephone | 540-373-2228
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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 | 0101058728
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License Number State | VA
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