Provider Demographics
NPI:1720111016
Name:PEDIATRIC ASSOCIATES OF MANASSAS
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF MANASSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ADONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-368-9131
Mailing Address - Street 1:9001 DIGGES RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4421
Mailing Address - Country:US
Mailing Address - Phone:703-368-9131
Mailing Address - Fax:703-368-2038
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4421
Practice Address - Country:US
Practice Address - Phone:703-368-9131
Practice Address - Fax:703-368-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty