Provider Demographics
NPI:1235222571
Name:PEDIATRIC CONSULTANTS OF HAMPTON ROADS
Entity Type:Organization
Organization Name:PEDIATRIC CONSULTANTS OF HAMPTON ROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDEN HOEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-875-9700
Mailing Address - Street 1:1405 KILN CREEK PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9700
Mailing Address - Country:US
Mailing Address - Phone:757-875-9700
Mailing Address - Fax:757-875-1028
Practice Address - Street 1:1405 KILN CREEK PKWY
Practice Address - Street 2:STE E
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9700
Practice Address - Country:US
Practice Address - Phone:757-875-9700
Practice Address - Fax:757-875-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046667261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6700047Medicaid
VA6700136Medicaid