=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831048487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSVILLE PEDIATRICS,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 829
-----------------------------------------------------
City | KEYSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23947-0829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-736-0544
-----------------------------------------------------
Fax | 434-736-8364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 829
-----------------------------------------------------
City | KEYSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23947-0829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-736-0544
-----------------------------------------------------
Fax | 434-736-8364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. NOEL ENCARNACION
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-603-1277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------