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General NPI Number Information
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NPI Number | 1992724181
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Entity Type | Organization
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Legal Business Name | NORTHSIDE PEDIATRICS PC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 2008 BREMO RD SUITE 100
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City | RICHMOND
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State | VA
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Zip | 23226-2443
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Country | US
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Telephone | 804-288-0814
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Fax | 877-331-0645
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Provider Business Mailing Address
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Address Line | PO BOX 28690
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City | RICHMOND
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State | VA
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Zip | 23228-8690
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Country | US
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Telephone | 804-432-4631
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Fax | 877-331-0645
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LAKEITA LYNNE SMITH
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Credential | MD
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Telephone | 804-432-4631
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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 | 0101231186
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License Number State | VA
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