Provider Demographics
NPI:1386785004
Name:VIRGINIA PEDIATRIC GROUP
Entity type:Organization
Organization Name:VIRGINIA PEDIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATRNER AT VIRGINIA PEDIATRIC GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-280-9597
Mailing Address - Street 1:10041 OAKTON TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2938
Mailing Address - Country:US
Mailing Address - Phone:703-242-8627
Mailing Address - Fax:
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-280-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty