| Organization Name: | THE PEDIATRIC GROUP, PC |
| NPI Number: | 1780808006 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL GRADER (ADMINISTRATOR) |
| Mailing Address: | 12506 A Lake Ridge Drive Lake Ridge |
| State: | VA US |
| Postal Code: | 22192 |
| Phone Number: | 7034944811 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |