Organization
RENAISSANCE PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA S BAUCOM MD (PRESIDENT)
(757) 488-2223
Entity
Organization
Contact information
Practice address
4012 RAINTREE RD, SUITE 200A, CHESAPEAKE, VA 23321-3741
(757) 488-2223
(757) 488-8398
Mailing address
4012 RAINTREE RD, SUITE 200A, CHESAPEAKE, VA 23321-3741
(757) 488-2223
(757) 488-8398
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
08/14/2006
Last updated
08/22/2020
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