Provider Demographics
NPI:1093146847
Name:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Other - Org Name:JAMES RIVER PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-794-1072
Mailing Address - Street 1:1521 HUGUENOT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2474
Mailing Address - Country:US
Mailing Address - Phone:804-794-1072
Mailing Address - Fax:804-794-5137
Practice Address - Street 1:1521 HUGUENOT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2474
Practice Address - Country:US
Practice Address - Phone:804-794-1072
Practice Address - Fax:804-794-5137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-04
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty