Provider Demographics
NPI:1710072145
Name:PEDIATRICS OF KEMPSVILLE, P.C.
Entity Type:Organization
Organization Name:PEDIATRICS OF KEMPSVILLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINFIELD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-523-4589
Mailing Address - Street 1:1212 LAKE JAMES DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6779
Mailing Address - Country:US
Mailing Address - Phone:757-523-4589
Mailing Address - Fax:757-523-8920
Practice Address - Street 1:1212 LAKE JAMES DR
Practice Address - Street 2:SUITE C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6779
Practice Address - Country:US
Practice Address - Phone:757-523-4589
Practice Address - Fax:757-523-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty