Organization
THE PEDIATRIC GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GRADER (ADMINISTRATOR)
(703) 971-6900
Entity
Organization
Contact information
Practice address
12506 A LAKE RIDGE DRIVE, LAKE RIDGE, VA 22192
(703) 494-4811
Mailing address
7015 C MANCHESTER BLVD., ALEXANDRIA, VA 22310
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
—
—
Other
Enumeration date
04/11/2007
Last updated
08/22/2020
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