Provider Demographics
NPI:1497894893
Name:RESTON PEDIATRICS ASSOCIATES,LTD
Entity Type:Organization
Organization Name:RESTON PEDIATRICS ASSOCIATES,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-262-0100
Mailing Address - Street 1:11130 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4398
Mailing Address - Country:US
Mailing Address - Phone:703-262-0100
Mailing Address - Fax:703-262-0333
Practice Address - Street 1:11130 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 150
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4398
Practice Address - Country:US
Practice Address - Phone:703-262-0100
Practice Address - Fax:703-262-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care