Provider Demographics
NPI:1023133410
Name:WARRENTON PEDIATRICS, LLC
Entity type:Organization
Organization Name:WARRENTON PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-349-3225
Mailing Address - Street 1:559 FROST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3044
Mailing Address - Country:US
Mailing Address - Phone:540-349-3225
Mailing Address - Fax:540-349-1204
Practice Address - Street 1:559 FROST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3044
Practice Address - Country:US
Practice Address - Phone:540-349-3225
Practice Address - Fax:540-349-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231776208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTIN