Provider Demographics
NPI:1639379159
Name:VAN DORN PEDIATRICS, PC
Entity Type:Organization
Organization Name:VAN DORN PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRAWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-933-0555
Mailing Address - Street 1:2500 N VAN DORN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1601
Mailing Address - Country:US
Mailing Address - Phone:703-933-0555
Mailing Address - Fax:703-933-0999
Practice Address - Street 1:2500 N VAN DORN ST STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1601
Practice Address - Country:US
Practice Address - Phone:703-933-0555
Practice Address - Fax:703-933-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232408261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care