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General NPI Number Information
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NPI Number | 1912128240
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CENTER PC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 901 ENTERPRISE PKWY SUITE 200
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City | HAMPTON
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State | VA
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Zip | 23666-6249
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Country | US
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Telephone | 757-826-5437
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Fax | 757-826-0721
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Provider Business Mailing Address
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Address Line | 901 ENTERPRISE PARKWAY SUITE 200
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City | HAMPTON
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State | VA
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Zip | 23666
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Country | US
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Telephone | 757-826-5437
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Fax | 757-826-0721
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK E HOLMAN
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Credential | MD
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Telephone | 757-826-5437
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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 | 0101045706
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License Number State | VA
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