Provider Demographics
NPI:1457381766
Name:PEDIATRIC PARTNERS OF STAFFORD PC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF STAFFORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-720-2126
Mailing Address - Street 1:110 SOARING EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556
Mailing Address - Country:US
Mailing Address - Phone:540-720-2126
Mailing Address - Fax:540-720-1002
Practice Address - Street 1:110 SOARING EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556
Practice Address - Country:US
Practice Address - Phone:540-720-2126
Practice Address - Fax:540-720-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09855Medicare PIN