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Organization

SOUTHSIDE PEDIATRICS, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERESITA DIONISIO M.D. (OWNER)
(434) 392-9438
Entity
Organization

Contact information

Practice address
502 BEECH ST, FARMVILLE, VA 23901-1222
(434) 392-9438
(434) 392-7630
Mailing address
502 BEECH ST, FARMVILLE, VA 23901-1222
(434) 392-9438
(434) 392-7630

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
0101035421
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006702767
VA
05
010018579
VA
01
081150
DR D ANTHEM#
VA
01
99161
OPTIMA # DR D
VA
Enumeration date
10/24/2006
Last updated
06/09/2022
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