| Old Dominion Pediatrics, Pllc | |
|
9323 Midlothian Tpke Suite E North Chesterfield VA 23235-4942 | |
| (804) 212-1144 | |
| (888) 681-1473 |
| Full Name | Old Dominion Pediatrics, Pllc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 9323 Midlothian Tpke, North Chesterfield, Virginia |
| Authorized Official Name and Position | Eric Bernard Freeman (PRESIDENT) |
| Authorized Official Contact | 8042121144 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Dominion Pediatrics, Pllc 9323 Midlothian Tpke Suite E North Chesterfield VA 23235-4942 Ph: (804) 212-1144 | Old Dominion Pediatrics, Pllc 9323 Midlothian Tpke Suite E North Chesterfield VA 23235-4942 Ph: (804) 212-1144 |
| NPI Number | 1710233788 |
|---|---|
| Provider Enumeration Date | 07/27/2012 |
| Last Update Date | 07/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710233788 | NPI | - | NPPES |
| 1578577086 | Medicaid | VA | |
| 010213720 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101238680 (Virginia) | Primary |
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