=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932286903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESTERFIELD PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5955 HARBOUR PARK DR
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-744-4495
-----------------------------------------------------
Fax | 804-744-0751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5955 HARBOUR PARK DR
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-744-4495
-----------------------------------------------------
Fax | 804-744-0751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL
-----------------------------------------------------
Name | ARLENE HARRINGTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 804-744-4495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------