Provider Demographics
NPI:1881016632
Name:P.W. PEDIATRICS P.C.
Entity Type:Organization
Organization Name:P.W. PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIRTICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBERAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:571-402-7130
Mailing Address - Street 1:4001 PRINCE WILLIAM PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7666
Mailing Address - Country:US
Mailing Address - Phone:571-402-7130
Mailing Address - Fax:571-285-2166
Practice Address - Street 1:4001 PRINCE WILLIAM PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7666
Practice Address - Country:US
Practice Address - Phone:571-402-7130
Practice Address - Fax:571-285-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10101058221251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497831051Medicaid