Provider Demographics
NPI:1164574950
Name:PEDIATRIC HEALTH PARTNERS,PLLC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH PARTNERS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:JAMIAS
Authorized Official - Last Name:SOLORIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-966-9873
Mailing Address - Street 1:3701 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707
Mailing Address - Country:US
Mailing Address - Phone:757-966-9873
Mailing Address - Fax:757-967-9547
Practice Address - Street 1:3701 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3121
Practice Address - Country:US
Practice Address - Phone:757-966-9873
Practice Address - Fax:757-967-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035962 & 0101046261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2127819OtherMAMSI
VA2461504 & 2696905OtherCIGNA
VA75160OtherOPTIMA HEALTH
VA2696905OtherCIGNA
VA010057361 & 01005733Medicaid
VA5514567 & 5514570OtherFIRST HEALTH
VA137078 & 137133OtherANTHEM
VA3652536 & 3652579OtherAETNA