Provider Demographics
NPI:1821247503
Name:MOUNTAIN VIEW INTERNAL MEDICINE AND PEDIATRICS INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW INTERNAL MEDICINE AND PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-248-0167
Mailing Address - Street 1:15195 HEATHCOAT BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6242
Mailing Address - Country:US
Mailing Address - Phone:571-248-0167
Mailing Address - Fax:571-248-0173
Practice Address - Street 1:15195 HEATHCOAT BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6242
Practice Address - Country:US
Practice Address - Phone:571-248-0167
Practice Address - Fax:571-248-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243618207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty