| Prince William Pediatrics And Adolescent Center | |
|
12722 Directors Loop Woodbridge VA 22192-2462 | |
| (703) 492-1400 | |
| (703) 492-0220 |
| Full Name | Prince William Pediatrics And Adolescent Center |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 12722 Directors Loop, Woodbridge, Virginia |
| Authorized Official Name and Position | Ali Jadidi (DIRECTOR) |
| Authorized Official Contact | 7034921400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prince William Pediatrics And Adolescent Center 12722 Directors Loop Woodbridge VA 22192-2462 Ph: (703) 492-1400 | Prince William Pediatrics And Adolescent Center 12722 Directors Loop Woodbridge VA 22192-2462 Ph: (703) 492-1400 |
| NPI Number | 1689965865 |
|---|---|
| Provider Enumeration Date | 04/22/2011 |
| Last Update Date | 04/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689965865 | NPI | - | NPPES |
| 1154567352 | Medicaid | VA | |
| 1013010180 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101230761 (Virginia) | Primary |
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