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Organization

PEDIATRIC PARTNERS OF NORTHERN VIRGINIA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MAUREEN BANTA M.D. (OWNER)
(703) 502-4500
Entity
Organization

Contact information

Practice address
4211 FAIRFAX CORNER EAST AVE, SUITE 225, FAIRFAX, VA 22030-8622
(703) 502-4500
(703) 502-4518
Mailing address
4211 FAIRFAX CORNER EAST AVE, SUITE 225, FAIRFAX, VA 22030-8622
(703) 502-4500
(703) 502-4518

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Enumeration date
03/17/2008
Last updated
03/17/2008
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