Provider Demographics
NPI:1447519715
Name:CHILDREN & ADOLESCENT PEDIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:CHILDREN & ADOLESCENT PEDIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAQIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-299-6648
Mailing Address - Street 1:161 FORT EVANS RD NE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3369
Mailing Address - Country:US
Mailing Address - Phone:703-777-5224
Mailing Address - Fax:703-777-5227
Practice Address - Street 1:161 FORT EVANS RD NE
Practice Address - Street 2:SUITE 330
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3369
Practice Address - Country:US
Practice Address - Phone:703-777-5224
Practice Address - Fax:703-777-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10101251326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty