# PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659441608
- **Authorized official:** MRS. KERRY KOVARIK (OFFICE MANAGER)
- **Authorized official phone:** (434) 296-9161

## Contact information

- **Practice address:** 1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
- **Practice address phone:** (434) 296-9161
- **Mailing address:** 1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
- **Mailing address phone:** (434) 296-9161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 2201000509 | VA | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01107700000 | SOUTHERN HEALTH | VA |
| 01 | — | 451205 | TRIGON/BLUE CROSS BLUE SH | VA |
| 01 | — | 8773895002 | CIGNA | VA |
| 05 | — | 9450271 | — | VA |