MEDICARE: PEDIATRIC PARTNERS OF VIRGINIA

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	:	1841997822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERS OF VIRGINIA

Provider Business Mailing Address
First Line	:	P.O. BOX 76354
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4735
Country	:	US
Telephone Number	:	804-464-2018
Fax Number	:	804-464-2535

Provider Business Practice Location Address
First Line	:	1583 STANDING RIDGE DR
Second Line	:
City	:	POWHATAN
State	:	VA
Zip	:	23139-8051
Country	:	US
Telephone Number	:	804-464-2018
Fax Number	:	804-464-2535

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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