Provider Demographics
NPI:1649666728
Name:CENTURY PEDIATRICS, INC
Entity type:Organization
Organization Name:CENTURY PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADIRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-899-7593
Mailing Address - Street 1:22445 CONSERVANCY DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8068
Mailing Address - Country:US
Mailing Address - Phone:703-899-7593
Mailing Address - Fax:540-288-8387
Practice Address - Street 1:385 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1545
Practice Address - Country:US
Practice Address - Phone:540-288-1551
Practice Address - Fax:540-288-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty