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Organization
THE PEDIATRIC VILLAGE
Active
Organization
THE PEDIATRIC VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX TORRES (BILLING MGR)
(703) 684-4581
Entity
Organization
Contact information
Practice address
4910 MASSACHUSETTS AVE NW, SUITE 217, WASHINGTON, DC 20016-4300
(202) 244-1553
Mailing address
4910 MASSACHUSETTS AVE NW, SUITE 217, WASHINGTON, DC 20016-4300
(202) 244-1553
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6466
CAREFIRST FEDERAL
DC
Enumeration date
08/17/2007
Last updated
08/17/2007
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