Provider Demographics
NPI:1134152077
Name:MARION PEDIATRIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MARION PEDIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-783-8183
Mailing Address - Street 1:590 RADIO HILL RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4224
Mailing Address - Country:US
Mailing Address - Phone:276-783-8183
Mailing Address - Fax:276-782-9267
Practice Address - Street 1:590 RADIO HILL RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4224
Practice Address - Country:US
Practice Address - Phone:276-783-8183
Practice Address - Fax:276-782-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101239136Medicaid
B59770Medicare UPIN
G79032Medicare UPIN
E97095Medicare UPIN
VA0101239136Medicaid