Provider Demographics
NPI:1447387865
Name:PENINSULA PEDIATRICS LTD
Entity Type:Organization
Organization Name:PENINSULA PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-873-3334
Mailing Address - Street 1:11835 FISHING POINT DR
Mailing Address - Street 2:STE 207
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2585
Mailing Address - Country:US
Mailing Address - Phone:757-875-3334
Mailing Address - Fax:757-873-1128
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:STE 207
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2585
Practice Address - Country:US
Practice Address - Phone:757-875-3334
Practice Address - Fax:757-873-1128
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty