Provider Demographics
NPI:1346303062
Name:PINE GROVE PEDIATRICS
Entity Type:Organization
Organization Name:PINE GROVE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-393-9494
Mailing Address - Street 1:8650 SUDLEY RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4419
Mailing Address - Country:US
Mailing Address - Phone:703-393-9494
Mailing Address - Fax:703-393-8591
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4419
Practice Address - Country:US
Practice Address - Phone:703-393-9494
Practice Address - Fax:703-393-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty