Organization
PEDIATRIC PRIMARY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN LEWIS PILLSBURY DAVID MD (PRESIDENT)
(804) 674-1985
Entity
Organization
Contact information
Practice address
2500 POCOSHOCK PL, SUITE 302, RICHMOND, VA 23235-6345
(804) 674-1985
(804) 276-1048
Mailing address
2500 POCOSHOCK PL, SUITE 302, RICHMOND, VA 23235-6345
(804) 674-1985
(804) 276-1048
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111185
OPTIMA HEALTHCARE
VA
01
—
1764809
UNITED HEALTHCARE
VA
01
—
231001
ANTHEM
VA
Enumeration date
10/17/2006
Last updated
11/10/2009
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