Provider Demographics
NPI:1225155781
Name:ASSOCIATES IN PEDIATRICS
Entity Type:Organization
Organization Name:ASSOCIATES IN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DERCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-364-4400
Mailing Address - Street 1:11551 NUCKOLS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5565
Mailing Address - Country:US
Mailing Address - Phone:808-364-4400
Mailing Address - Fax:804-364-0120
Practice Address - Street 1:11551 NUCKOLS RD
Practice Address - Street 2:SUITE F
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5565
Practice Address - Country:US
Practice Address - Phone:808-364-4400
Practice Address - Fax:804-364-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty