Southside Spectrum Pediatrics
Pediatrics in Virginia Beach, VA. Organization (NPI-2).
NPI number1013661917
StatusActive
Last updated in NPPESDec 15, 2022
Details
- NPI
- 1013661917
- Entity type
- Organization (NPI-2)
- Legal business name
- Southside Spectrum Pediatrics
- Organization subpart
- No
- Enumeration date
- Feb 9, 2022
- Certification date
- Dec 15, 2022
- Last updated
- Dec 15, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
Practice location
5320 Providence Rd Ste 100Virginia Beach, VA 23464-4122
Phone 757-451-5000
Mailing address
5320 Providence Rd Ste 100Virginia Beach, VA 23464-4122
Phone 757-937-3029 · Fax 757-937-8290
Authorized official
Tambra Hollingsworth
Owner
7579373029
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