Provider Demographics
NPI:1427185784
Name:VIRGO CARTER PEDIATRICS
Entity Type:Organization
Organization Name:VIRGO CARTER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VIRGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-565-3999
Mailing Address - Street 1:1109 SPRING STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4030
Mailing Address - Country:US
Mailing Address - Phone:301-565-3999
Mailing Address - Fax:301-576-6259
Practice Address - Street 1:1109 SPRING STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4030
Practice Address - Country:US
Practice Address - Phone:301-565-3999
Practice Address - Fax:301-576-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42811208000000X
MDD43490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty