Provider Demographics
NPI:1114162476
Name:PEDIATRICS AT THE HAMPTONS
Entity Type:Organization
Organization Name:PEDIATRICS AT THE HAMPTONS
Other - Org Name:DR. ANGELA ODOM AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ODOM AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-247-1111
Mailing Address - Street 1:410 MARCELLA RD
Mailing Address - Street 2:B
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2487
Mailing Address - Country:US
Mailing Address - Phone:757-247-1111
Mailing Address - Fax:757-825-5740
Practice Address - Street 1:410B MARCELLA RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2487
Practice Address - Country:US
Practice Address - Phone:757-247-1111
Practice Address - Fax:757-825-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006754406Medicaid