Provider Demographics
NPI:1558428953
Name:CENTURY PEDIATRICS INC.
Entity Type:Organization
Organization Name:CENTURY PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADIRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:571-334-6978
Mailing Address - Street 1:22445 CONSERVANCY DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8068
Mailing Address - Country:US
Mailing Address - Phone:703-680-6641
Mailing Address - Fax:
Practice Address - Street 1:2024 OPITZ BLVD STE A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3388
Practice Address - Country:US
Practice Address - Phone:703-492-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189147OtherFREDERICKSBURG HEALTHKEEP
VA386437OtherHEALTHKEEPERS PLUS STAFFO
VA5686693OtherAETNA
VA010236568Medicaid
VA259327OtherHEALTHKEEPERS PLUS WOODBR
VA006739491Medicaid
VA897801OtherALLIANCE PPO
VA98446OtherAMERIGROUP
VA006720421Medicaid
VA5686693OtherAETNA