Organization
THE PEDIATRIC GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAN MICHAEL GRADER MHA (ADMINISTRATOR)
(703) 971-6900
Entity
Organization
Contact information
Practice address
7015C MANCHESTER BLVD, ALEXANDRIA, VA 22310-3253
(703) 971-6900
(703) 971-9184
Mailing address
7015C MANCHESTER BLVD, ALEXANDRIA, VA 22310-3253
(703) 971-6900
(703) 971-9184
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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