Provider Demographics
NPI:1962686865
Name:ADVANCED PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ADVANCED PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-938-5555
Mailing Address - Street 1:100 EAST ST SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4800
Mailing Address - Country:US
Mailing Address - Phone:703-938-5555
Mailing Address - Fax:703-319-8580
Practice Address - Street 1:100 EAST ST SE
Practice Address - Street 2:SUITE 301
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4800
Practice Address - Country:US
Practice Address - Phone:703-938-5555
Practice Address - Fax:703-319-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty