Provider Demographics
NPI:1750471850
Name:CHILDREN & ADOLESCENTS CLINIC, INC
Entity Type:Organization
Organization Name:CHILDREN & ADOLESCENTS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARUWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-541-8812
Mailing Address - Street 1:308 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2506
Mailing Address - Country:US
Mailing Address - Phone:804-541-8812
Mailing Address - Fax:804-541-1396
Practice Address - Street 1:308 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2506
Practice Address - Country:US
Practice Address - Phone:804-541-8812
Practice Address - Fax:804-541-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010320062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty