Provider Demographics
NPI:1932545803
Name:KIDS FIRST PEDIATRICS OF STAFFORD, PC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS OF STAFFORD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEGRETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-288-8821
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-2165
Mailing Address - Country:US
Mailing Address - Phone:540-288-8821
Mailing Address - Fax:540-288-8875
Practice Address - Street 1:2765 JEFFERSON DAVIS HWY STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8331
Practice Address - Country:US
Practice Address - Phone:540-288-8821
Practice Address - Fax:540-288-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760434492Medicaid