Provider Demographics
NPI:1710928437
Name:THE PEDIATRIC GROUP, PC
Entity Type:Organization
Organization Name:THE PEDIATRIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-971-6900
Mailing Address - Street 1:7015C MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3253
Mailing Address - Country:US
Mailing Address - Phone:703-971-6900
Mailing Address - Fax:703-971-9184
Practice Address - Street 1:7015C MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3253
Practice Address - Country:US
Practice Address - Phone:703-971-6900
Practice Address - Fax:703-971-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407814403OtherT. GARRETT, MD
VA1700844701OtherA. KAPOOR, MD
VA1427016864OtherV. GIANNUZZI, MD
VA1205884434OtherE. LIN, MD
VA1255399382OtherN. LEYKAM, MD
VA1225096373OtherE. CAVROS, MD
VA1689632028OtherC. FUGATE, MD
VA1235187725OtherE. PALUMBO, MD