THE PEDIATRIC GROUP, PC (NPI# 1780808006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780808006 |
| Entity Type | Organization |
| Organization Name | THE PEDIATRIC GROUP, PC |
| Practice Address |
12506 A Lake Ridge Drive Lake Ridge VA 22192 |
| Mailing Address |
7015 C Manchester Blvd. Alexandria VA 22310 |
| Practice Telephone | 7034944811 |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL GRADER (ADMINISTRATOR) |
| Authorized Official Telephone | 7039716900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0200X |
Registered Nurse Specialization: Pediatrics |
Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851515175 | The Pediatric Group, PC | Registered Nurse | 10527 Braddock Road, Fairfax, VA 22032 | 2007-04-11 |
| 1023232345 | The Pediatric Group, PC | Registered Nurse | 3914 Centreville Road, Chantilly, VA 20151 | 2007-04-11 |
| 1922162205 | The Pediatric Group, PC | Pediatrics | 7015c Manchester Blvd, Alexandria, VA 22310-3253 | 2006-12-20 |
| 1710928437 | The Pediatric Group, PC | Pediatrics | 7015c Manchester Blvd, Alexandria, VA 22310-3253 | 2006-06-10 |
| Street Address |
12506 A LAKE RIDGE DRIVE |
| City | LAKE RIDGE |
| State | VA |
| Zip Code | 22192 |
| 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 | 163WP0200X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366057119 | Stephanie Keeling | Registered Nurse | 1223 Rowland Dr, Herndon, VA 20170-2430 | 2020-09-09 |
| 1639638273 | Brittani Jordan | Registered Nurse | 6171 Fawnlake Ct, New Kent, VA 23124-2977 | 2019-03-13 |
| 1013382837 | Carrie Shreve Entsminger | Registered Nurse | 11810 Murray Hill Dr, Midlothian, VA 23113-2342 | 2015-12-04 |
| 1245504083 | April Rose De Leon | Registered Nurse | 2503 E Little Creek Rd, Apt #5, Norfolk, VA 23518-3343 | 2012-02-24 |
| 1629341508 | Danielle Louise Henry | Registered Nurse | 4211 Heather Rd, Portsmouth, VA 23703-1621 | 2012-02-22 |
| 1801169784 | Karissa J Richardson | Registered Nurse | 826 Priscilla Ln, Chesapeake, VA 23322-3719 | 2012-02-22 |
| 1073886842 | April Gilbrech | Registered Nurse | 1103 Canopy Ct, Virginia Beach, VA 23455 | 2012-02-09 |
| 1225255938 | Janet Ann Williams-janas | Registered Nurse | 6419 Chapel View Rd, Clifton, VA 20124-1944 | 2007-04-20 |
| 1851515175 | The Pediatric Group, PC | Registered Nurse | 10527 Braddock Road, Fairfax, VA 22032 | 2007-04-11 |
| 1023232345 | The Pediatric Group, PC | Registered Nurse | 3914 Centreville Road, Chantilly, VA 20151 | 2007-04-11 |
| Find all providers with the same taxonomy | ||||
| City | LAKE RIDGE |
| Zip Code | 22192 |
Please comment or provide details below to improve the information on THE PEDIATRIC GROUP, PC.
| 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.