Provider Demographics
NPI:1528103645
Name:STEVENSON PEDIATRICS
Entity type:Organization
Organization Name:STEVENSON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:DANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-823-2400
Mailing Address - Street 1:6000 STEVENSON AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3577
Mailing Address - Country:US
Mailing Address - Phone:703-823-2400
Mailing Address - Fax:703-823-2013
Practice Address - Street 1:6000 STEVENSON AVE
Practice Address - Street 2:STE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3577
Practice Address - Country:US
Practice Address - Phone:703-823-2400
Practice Address - Fax:703-823-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010325462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA58692OtherAMERIGROUP
VA090804OtherAETNA US HEALTHCARE HMO
VA231691OtherANTHEM HEALTH KEEPERS PLU
VA407481OtherAETNA US HEALTHCARE PPO