Organization
CHILDRENS SPECIALTY GROUP PLLC
Active
Other names
CSG - Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD MARINO (CHIEF EXECUTIVE OFFICER)
(757) 668-7007
Entity
Organization
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7007
(757) 668-8658
Mailing address
811 REDGATE AVE, NORFOLK, VA 23507-1515
(757) 668-7007
(757) 668-8658
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG6353
RAILROAD MEDICARE GRP PIN
VA
Enumeration date
07/25/2006
Last updated
06/19/2019
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