OLD DOMINION PEDIATRICS PLLC NPI 1710233788

NPI Information

NPI: 1710233788
Provider Name: OLD DOMINION PEDIATRICS, PLLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 49D2043752

Address:
9323 MIDLOTHIAN TPKE
SUITE E
NORTH CHESTERFIELD, VA
ZIP 23235
Phone: (804) 212-1144
Get Directions

OLD DOMINION PEDIATRICS, PLLC is a primary care clinic center in North Chesterfield, VA. OLD DOMINION PEDIATRICS, PLLC NPI is 1710233788. The provider is registered as an organization entity type.

The provider's business location address is:

9323 MIDLOTHIAN TPKE
SUITE E
NORTH CHESTERFIELD, VA
ZIP 23235-942
Phone: (804) 212-1144
Fax: (888) 681-1473

The provider's authorized official is Eric Bernard Freeman .
The authorized official title is President and has the following contact phone number (804) 212-1144.

The CLIA number assigned to this NPI record is 49D2043752 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/27/2012 and was last updated on 7/27/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	0101238680	VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1578577086	MEDICAID	VIRGINIA
2	010213720	MEDICAID	VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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