Provider Demographics
NPI:1992997449
Name:THE PEDIATRIC VILLAGE
Entity type:Organization
Organization Name:THE PEDIATRIC VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-684-4581
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4300
Mailing Address - Country:US
Mailing Address - Phone:202-244-1553
Mailing Address - Fax:
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4300
Practice Address - Country:US
Practice Address - Phone:202-244-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6466OtherCAREFIRST FEDERAL