Provider Demographics
NPI:1629329610
Name:PEDIATRICS, INC
Entity Type:Organization
Organization Name:PEDIATRICS, INC
Other - Org Name:PEDIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-545-5050
Mailing Address - Street 1:10571 TELEGRAPH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4652
Mailing Address - Country:US
Mailing Address - Phone:804-266-9616
Mailing Address - Fax:804-261-4935
Practice Address - Street 1:10571 TELEGRAPH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:804-266-9616
Practice Address - Fax:804-261-4935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170051363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty