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General NPI Number Information
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NPI Number | 1871709899
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Entity Type | Organization
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Legal Business Name | ADULT AND PEDIATRIC MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 3800 POPLAR HILL RD STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5522
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Country | US
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Telephone | 757-484-2001
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Fax | 757-484-2182
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Provider Business Mailing Address
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Address Line | 3800 POPLAR HILL RD STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5522
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Country | US
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Telephone | 757-484-2001
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Fax | 757-484-2182
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MISS LUKIA DEWITT BEVERLY
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Credential | CPNP
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Telephone | 757-484-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101224920
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License Number State | VA
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