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Organization

MED-PEDS MANAGEMENT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SUSAN JANET MOLE (PRACTICE MGR CORP. SECRETARY)
(276) 623-8105
Entity
Organization

Contact information

Practice address
191 JOHNSON ST NE, ABINGDON, VA 24210-2934
(276) 623-8105
(276) 623-8109
Mailing address
PO BOX 570, ABINGDON, VA 24212-0570
(276) 623-8105
(276) 623-8109

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101051200
VA
207R00000X
Internal Medicine Physician
0101225410
VA
208000000X
Pediatrics Physician
0101028204
VA
208000000X
Pediatrics Physician
0101050628
VA
208000000X
Pediatrics Physician
0101051074
VA
208000000X
Pediatrics Physician
0101059370
VA
363LF0000X
Family Nurse Practitioner
0024059099
VA
363LF0000X
Family Nurse Practitioner
0024166814
VA

Other

Enumeration date
02/05/2007
Last updated
11/01/2010
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