Provider Demographics
NPI:1942459888
Name:PEDIATRICS AND INTERNAL MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:PEDIATRICS AND INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-247-3910
Mailing Address - Street 1:2501 MARSHALL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4636
Mailing Address - Country:US
Mailing Address - Phone:757-847-3910
Mailing Address - Fax:757-245-0203
Practice Address - Street 1:2501 MARSHALL AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4636
Practice Address - Country:US
Practice Address - Phone:757-847-3910
Practice Address - Fax:757-245-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization