MEDICARE: PEDIATRIC PARTNERSHIP

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	305S00000X	Point of Service		VA

General Provider Information

NPI Number	:	1629266812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERSHIP

Provider Business Mailing Address
First Line	:	100 CONCOURSE BLVD
Second Line	:	SUITE 111
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5642
Country	:	US
Telephone Number	:	804-377-8981
Fax Number	:	804-377-8984

Provider Business Practice Location Address
First Line	:	100 CONCOURSE BLVD
Second Line	:	SUITE 111
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5642
Country	:	US
Telephone Number	:	804-377-8981
Fax Number	:	804-377-8984

Authorized Official
Title or Position	:	OWNER
Name	:	JILL E RYLAND
Credential	:	M.D.
Telephone Number	:	804-377-8981

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/12/2007

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