Organization
ELDEN ST. PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILLICENT M TETTEYFIO RN (RN.OFC.MGR)
(703) 471-6996
Entity
Organization
Contact information
Practice address
110 ELDEN ST, SUITE #D, HERNDON, VA 20170-4891
(703) 471-6996
(703) 435-7765
Mailing address
110 ELDEN ST, SUITE #D, HERNDON, VA 20170-4891
(703) 471-6996
(703) 435-7765
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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