Provider Demographics
NPI:1063450070
Name:PEDIATRIC CARDIOLOGY OF VIRGINIA
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-1611
Mailing Address - Street 1:7603 FOREST AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4942
Mailing Address - Country:US
Mailing Address - Phone:804-285-1611
Mailing Address - Fax:804-285-1615
Practice Address - Street 1:7603 FOREST AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4942
Practice Address - Country:US
Practice Address - Phone:804-285-1611
Practice Address - Fax:804-285-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID