MEDICARE: CALDWELL PEDIATRICS AND WELLNESS CENTER PC

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	208000000X	Pediatrics Physician	0101054172	VA

General Provider Information

NPI Number	:	1417974338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDWELL PEDIATRICS AND WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	2425 BOULEVARD
Second Line	:	SUITE #6
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2324
Country	:	US
Telephone Number	:	804-520-0002
Fax Number	:	804-520-2259

Provider Business Practice Location Address
First Line	:	2425 BOULEVARD
Second Line	:	SUITE #6
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2324
Country	:	US
Telephone Number	:	804-520-0002
Fax Number	:	804-520-2259

Authorized Official
Title or Position	:	DOCTOR/PRESIDENT
Name	:	DR. MELANEY ARMSTRONG CALDWELL
Credential	:	M.D.
Telephone Number	:	804-520-0002

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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