Organization
PRINCE EDWARD PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IBTEHAL AL-ANI (PHYICIAN)
(434) 315-0138
Entity
Organization
Contact information
Practice address
1715 W 3RD ST, FARMVILLE, VA 23901-2651
(434) 315-0138
(434) 392-9748
Mailing address
PO BOX 97, RICE, VA 23966-0097
(434) 315-0138
(434) 392-9748
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101242689
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609040658
—
VA
Enumeration date
07/25/2014
Last updated
07/25/2014
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