Provider Demographics
NPI:1447382940
Name:STAFFORD PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:STAFFORD PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN, SOLE PRACTITIONER, PR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:540-659-0111
Mailing Address - Street 1:385 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1545
Mailing Address - Country:US
Mailing Address - Phone:540-659-0111
Mailing Address - Fax:540-720-5867
Practice Address - Street 1:385 GARRISONVILLE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1545
Practice Address - Country:US
Practice Address - Phone:540-659-0111
Practice Address - Fax:540-720-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036605261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6780073Medicaid