Organization
PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KERRY KOVARIK (OFFICE MANAGER)
(434) 296-9161
Entity
Organization
Contact information
Practice address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
Mailing address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000509
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01107700000
SOUTHERN HEALTH
VA
01
—
451205
TRIGON/BLUE CROSS BLUE SH
VA
01
—
8773895002
CIGNA
VA
05
—
9450271
—
VA
Enumeration date
11/08/2006
Last updated
08/22/2020
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