Provider Demographics
NPI:1225118532
Name:PEDIATRIC PRIMARY CARE, PC
Entity Type:Organization
Organization Name:PEDIATRIC PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PILLSBURY DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-674-1985
Mailing Address - Street 1:2500 POCOSHOCK PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-674-1985
Mailing Address - Fax:804-276-1048
Practice Address - Street 1:2500 POCOSHOCK PL
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-674-1985
Practice Address - Fax:804-276-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1764809OtherUNITED HEALTHCARE
VA231001OtherANTHEM
VA111185OtherOPTIMA HEALTHCARE