Provider Demographics
NPI:1114091931
Name:UNION MILL PEDIATRICS,PC
Entity Type:Organization
Organization Name:UNION MILL PEDIATRICS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ERIKSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-802-6304
Mailing Address - Street 1:13880 BRADDOCK RD. STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-802-6304
Mailing Address - Fax:703-802-6307
Practice Address - Street 1:13880 BRADDOCK RD. STE 201
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-802-6304
Practice Address - Fax:703-802-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty