NPIMap

Organization Active NPI

Advanced Pediatrics PLLC

  • Pediatrics Physician
  • Vienna, VA
National Provider Identifier
1962686865
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ADVANCED PEDIATRICS PLLC
Practice address
100 East St SE
Suite 301
Vienna, VA 22180-4800
Phone
(703) 938-5555
Fax
(703) 319-8580
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lisa M Jackson
Title
Office Manager
Phone
(703) 938-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

100 East St SE
Suite 301
Vienna, VA 22180-4800

Mailing address

100 East St SE
Suite 301
Vienna, VA 22180-4800
Phone (703) 938-5555

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1962686865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EAST ST SE",
            "address_2": "SUITE 301",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804800",
            "telephone_number": "703-938-5555",
            "fax_number": "703-319-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EAST ST SE",
            "address_2": "SUITE 301",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804800",
            "telephone_number": "703-938-5555",
            "fax_number": "703-319-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-938-5555",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.