MEDICARE: PEDIATRIC PARTNERS OF VIRGINIA, LLC

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

General Provider Information

NPI Number	:	1780023994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERS OF VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	9020 STONY POINT PKWY STE 165
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1960
Country	:	US
Telephone Number	:	804-464-2018
Fax Number	:	804-464-2535

Provider Business Practice Location Address
First Line	:	9020 STONY POINT PKWY STE 165
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1960
Country	:	US
Telephone Number	:	804-364-4400
Fax Number	:	804-364-0120

Authorized Official
Title or Position	:	CORPORATE OPERATIONS MANAGER
Name	:	SAMANTHA SEMEJA
Credential	:	MBA
Telephone Number	:	804-464-2018

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	11/30/2022

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