MEDICARE: COVINGTON PEDIATRICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	S4522894	VA

General Provider Information

NPI Number	:	1093150468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVINGTON PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	411 W RIVERSIDE ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 W RIVERSIDE ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1273
Country	:	US
Telephone Number	:	304-667-7332
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TIMOTHY J YORK
Credential	:	DO
Telephone Number	:	304-667-7332

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/30/2013

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