PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER (NPI# 1689965865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689965865 |
| Entity Type | Organization |
| Organization Name | PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER |
| Practice Address |
12722 Directors Loop Woodbridge VA 22192-2462 |
| Practice Telephone | 7034921400 |
| Practice Fax Number | 7034920220 |
| Mailing Telephone | 7034921400 |
| Mailing Fax Number | 7034920220 |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2011-04-22 |
| Authorized Official Name | DR. ALI JADIDI (DIRECTOR) |
| Authorized Official Telephone | 7034921400 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
0101230761 | VA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1154567352 | 05 | |
| VA | 1013010180 | 05 |
| Street Address |
12722 DIRECTORS LOOP |
| City | WOODBRIDGE |
| State | VA |
| Zip Code | 22192-2462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154567352 | Manpreet Sidhu | Pediatrics | 12722 Directors Loop, Woodbridge, VA 22192-2462 | 2008-12-18 |
| 1982109641 | Caitlin Elise Mckearney | Nurse Practitioner | 12722 Directors Loop, Woodbridge, VA 22192-2462 | 2018-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245873645 | Ursula Jackson | Technician | 3500 Commission Ct, Woodbridge, VA 22192 | 2019-10-18 |
| 1205480779 | Ki Soo Park | Physical Therapy Assistant | 12825 Minnieville Road Suite 201, Lake Ridge, VA 22192 | 2019-08-01 |
| 1801448329 | Karen Lee Trivett | Specialist/Technologist, Other | 12584 Darby Brook Court, Woodbridge, VA 22192 | 2019-07-15 |
| 1407313166 | Nichele Amelia Thompson | Behavioral Analyst | 2731 Marblestone Dr, 101, Woodbridge, VA 22192 | 2019-02-28 |
| 1952877870 | Kimberly Ann Rojas Vazquez | Behavioral Analyst | 12531 Clipper Dr, Suite 203, Woodbridge, VA 22192 | 2018-10-18 |
| 1104391614 | Ykim Dental | Dentist | 2680 Optiz Blvd., Suite 120, Woodbridge, VA 22192 | 2018-10-11 |
| 1013418755 | Arm Transport | Non-emergency Medical Transport (VAN) | 13000 Harbor Center Dr Ste 132d, Woodbridge, VA 22192 | 2018-02-27 |
| 1811496813 | Francesca Nasi | Behavioral Analyst | 12531 Clipper Dr Ste 203, Woodbridge, VA 22192 | 2018-02-05 |
| 1942729504 | Bismark Transportation Service LLC | Non-emergency Medical Transport (VAN) | 12341 Woodlawn Court, Woodbridge, VA 22192 | 2017-09-14 |
| 1992226344 | Arm Baby Eldery Home Health LLC | Home Health | 13000 Harbor Center Dr # 312c, Woodbridge, VA 22192 | 2017-07-06 |
| Find all providers in zip 22192 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013402593 | Mednovations LLC | Clinic/Center | 1712 Financial Loop, Woodbridge, VA 22192-2459 | 2018-06-26 |
| 1417355033 | Us Primary and Urgent Care Inc | Clinic/Center | 1342 Old Bridge Rd, Woodbridge, VA 22192-2708 | 2014-12-12 |
| 1790104487 | H&b Care Pllc | Clinic/Center | 13001 Summit School Rd Ste 3, Woodbridge, VA 22192-2903 | 2014-04-10 |
| 1942514435 | Oscar F Sugastti, Md, LLC | Clinic/Center | 2200 Opitz Blvd Ste 355, Woodbridge, VA 22191-3340 | 2010-07-27 |
| 1699227942 | Hematology Oncology Care of Northern Virginia | Clinic/Center | 1900 Opitz Blvd, Suite E & F, Woodbridge, VA 22191-3320 | 2016-11-02 |
| 1164858205 | Excel Medical Clinic, Inc. | Clinic/Center | 14904 Jefferson Davis Hwy, Suite 205, Woodbridge, VA 22191-3908 | 2013-09-20 |
| 1154661395 | Prime Wellness Clinic LLC | Clinic/Center | 14904 Jefferson Davis Hwy, Suite 305, Woodbridge, VA 22191-3908 | 2013-02-25 |
| 1003051897 | Potomac Pediatrics, P.C. | Clinic/Center | 2296 Opitz Blvd, Suite 510, Woodbridge, VA 22191-3300 | 2008-12-08 |
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| 1124626478 | Partners In Family Practice LLC | Clinic/Center | 430 Clairmont Ct Ste 123, Colonial Heights, VA 23834-1770 | 2020-10-09 |
| 1730790874 | Janice G. Sadaya-conda M.d., Pllc | Clinic/Center | 6128 Brandon Ave Ste 225, Springfield, VA 22150-2640 | 2020-08-12 |
| 1598375610 | Johnson Venture Management Solutions, Inc. | Clinic/Center | 17 Langley Blvd Bldg 1216, Hampton, VA 23681-2143 | 2020-08-04 |
| 1376161745 | Susan Minter Dnp Aprn LLC | Clinic/Center | 1234 Ridout Rd, La Crosse, VA 23950-2808 | 2020-07-11 |
| 1295359883 | Advanced Onsite Care LLC | Clinic/Center | 1045 Robert Welch Ln, Chesapeake, VA 23320-6770 | 2020-05-30 |
| 1962022392 | Gladeview Medical LLC | Clinic/Center | 279 Gladeview Dr, Fries, VA 24330-3936 | 2020-04-27 |
| 1578182986 | Libertas Leadership | Clinic/Center | 405 Sperryville Pike, Culpeper, VA 22701-2151 | 2020-04-15 |
| 1497395768 | Holistic Health and Healing Inc | Clinic/Center | 3690 Greensboro Road, Ridgeway, VA 24148 | 2020-01-14 |
| 1700426244 | Quad/med, LLC | Clinic/Center | 366 Draft Avenue, Stuarts Draft, VA 24477-2941 | 2020-01-13 |
| 1114560653 | Amy Beyer LLC | Clinic/Center | 2611 Thomas Jefferson Pkwy, Palmyra, VA 22963-5000 | 2019-10-28 |
| Find all providers with the same taxonomy | ||||
| City | WOODBRIDGE |
| Zip Code | 22192 |
Please comment or provide details below to improve the information on PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.