Organization
PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALI JADIDI M.D. (DIRECTOR)
(703) 492-1400
Entity
Organization
Contact information
Practice address
12722 DIRECTORS LOOP, WOODBRIDGE, VA 22192-2462
(703) 492-1400
(703) 492-0220
Mailing address
12722 DIRECTORS LOOP, WOODBRIDGE, VA 22192-2462
(703) 492-1400
(703) 492-0220
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101230761
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013010180
—
VA
05
—
1154567352
—
VA
Enumeration date
04/22/2011
Last updated
04/22/2011
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