Organization
PEDIATRIC CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E HOLMAN MD (PHYSICIAN)
(757) 826-5437
Entity
Organization
Contact information
Practice address
901 ENTERPRISE PKWY, SUITE 200, HAMPTON, VA 23666-6249
(757) 826-5437
(757) 826-0721
Mailing address
901 ENTERPRISE PARKWAY, SUITE 200, HAMPTON, VA 23666
(757) 826-5437
(757) 826-0721
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101045706
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006769357
—
VA
01
—
91788
BCBS
VA
Enumeration date
05/02/2007
Last updated
09/16/2015
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