Provider Demographics
NPI:1831286996
Name:MONUMENT AVENUE PEDIATRICS
Entity Type:Organization
Organization Name:MONUMENT AVENUE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-358-3027
Mailing Address - Street 1:3602 MONUMENT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3602 MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4905
Practice Address - Country:US
Practice Address - Phone:804-358-3027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164484820OtherMARY SCHWEIKER,M.D. NPI#
VA1619937752OtherB. WAYNE THORPE,M.D. NPI#
VA1639138209OtherGRANT MUSSMAN,M.D. NPI#
VA1457318651OtherGRACE SOLTYS,M.D. NPI#
VA=========OtherMON AVE PEDS TAX ID#
VA1639138209OtherGRANT MUSSMAN,M.D. NPI#
VA1619937752OtherB. WAYNE THORPE,M.D. NPI#
VA1164484820OtherMARY SCHWEIKER,M.D. NPI#