Provider Demographics
NPI:1396850699
Name:NOVA PEDIATRICS
Entity Type:Organization
Organization Name:NOVA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-451-3333
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2522
Mailing Address - Country:US
Mailing Address - Phone:703-451-3333
Mailing Address - Fax:703-451-7219
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-451-3333
Practice Address - Fax:703-451-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty