Provider Demographics
NPI:1104994623
Name:PEDIATRICARE OF NORTHERN VIRGINIA, P.C.
Entity type:Organization
Organization Name:PEDIATRICARE OF NORTHERN VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GIANCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-330-3939
Mailing Address - Street 1:8640 SUDLEY ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-330-3939
Mailing Address - Fax:703-331-0959
Practice Address - Street 1:8640 SUDLEY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4420
Practice Address - Country:US
Practice Address - Phone:703-330-3939
Practice Address - Fax:703-331-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty