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General NPI Number Information
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NPI Number | 1942651054
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Entity Type | Organization
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Legal Business Name | CHILDREN FIRST PEDIATRICS OF VIRGINIA, P.C.
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 314 FAIRY STREET EXT SUITE A
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1913
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Country | US
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Telephone | 276-638-5437
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Fax | 276-666-6686
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Provider Business Mailing Address
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Address Line | 314 FAIRY STREET EXT SUITE A
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1913
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Country | US
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Telephone | 276-638-5437
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Fax | 276-666-6686
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Authorized Official
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Title or Position | PEDIATRICIAN/OWNER
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Name | DR. MARY ELIZABETH NOONAN
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Credential | M.D.
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Telephone | 276-638-5437
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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 | 0101240119
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License Number State | VA
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