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General NPI Number Information
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NPI Number | 1972797256
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Entity Type | Organization
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Legal Business Name | COLONIAL HEIGHTS PEDIATRICS LTD.
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 16011 KAIROS RD SUITE 'A'
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-5205
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Country | US
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Telephone | 804-520-2600
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Fax | 604-520-5853
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Provider Business Mailing Address
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Address Line | 16011 KAIROS RD SUITE 'A'
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-5205
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Country | US
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Telephone | 804-520-2600
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Fax | 604-520-5853
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAWED IQBAL
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Credential | M.D.,
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Telephone | 804-520-2600
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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 |
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License Number State | VA
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