Organization
CHILDREN'S HEALTH CARE CENTER OF NOVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN WALLACE MCEACHERN M.D., F.A.A.P. (CEO/MD)
(703) 392-5437
Entity
Organization
Contact information
Practice address
9001 DIGGES RD STE 106, MANASSAS, VA 20110-4414
(703) 392-5437
Mailing address
9001 DIGGES RD STE 106, MANASSAS, VA 20110-4414
(703) 392-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101051497
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006724264
—
VA
Enumeration date
11/25/2008
Last updated
01/18/2011
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