Provider Demographics
NPI:1629546106
Name:CHILDRENS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL GROUP INC
Other - Org Name:NORFOLK PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CONTRACT DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-8565
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1529 INTERNATIONAL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-4802
Practice Address - Country:US
Practice Address - Phone:757-855-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty