Provider Demographics
NPI:1912338856
Name:HUGUENOT PEDIATRICS
Entity Type:Organization
Organization Name:HUGUENOT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-794-2299
Mailing Address - Street 1:1407 HUGUENOT ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-794-2299
Mailing Address - Fax:804-794-5774
Practice Address - Street 1:1407 HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2618
Practice Address - Country:US
Practice Address - Phone:804-794-2299
Practice Address - Fax:804-794-5774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC PARTNERS OF VIRGINIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty