Provider Demographics
NPI:1760413298
Name:NORFOLK PEDIATRICS, P.L.C.
Entity Type:Organization
Organization Name:NORFOLK PEDIATRICS, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-855-6800
Mailing Address - Street 1:1529 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-4802
Mailing Address - Country:US
Mailing Address - Phone:757-855-6800
Mailing Address - Fax:757-855-7771
Practice Address - Street 1:1529 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 103
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:757-855-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2695261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABO9303Medicare UPIN
VAF76947Medicare UPIN