Provider Demographics
NPI:1942630397
Name:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Other - Org Name:PEDIATRIC PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-363-0270
Mailing Address - Street 1:5207 HICKORY PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2624
Mailing Address - Country:US
Mailing Address - Phone:804-377-8981
Mailing Address - Fax:804-377-8984
Practice Address - Street 1:5207 HICKORY PARK DR STE C
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2624
Practice Address - Country:US
Practice Address - Phone:804-377-8981
Practice Address - Fax:804-377-8984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-22
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty