Provider Demographics
NPI:1912977687
Name:CHILDS, MARCELLA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:E
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 CONSTITUTION DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6799
Mailing Address - Country:US
Mailing Address - Phone:757-499-7442
Mailing Address - Fax:757-490-3638
Practice Address - Street 1:100 CONSTITUTION DR
Practice Address - Street 2:SUITE 217
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6799
Practice Address - Country:US
Practice Address - Phone:757-499-7442
Practice Address - Fax:757-490-3638
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912977687Medicaid