Provider Demographics
NPI:1457199515
Name:MAGNOLIA PEDIATRICS OF VIRGINIA
Entity type:Organization
Organization Name:MAGNOLIA PEDIATRICS OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:EAGAN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-755-1714
Mailing Address - Street 1:11404 SEYMOUR LN
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-4633
Mailing Address - Country:US
Mailing Address - Phone:504-452-3090
Mailing Address - Fax:
Practice Address - Street 1:4448 GERMANNA HWY STE 4C
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2012
Practice Address - Country:US
Practice Address - Phone:540-755-1714
Practice Address - Fax:540-779-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty