Basic Information
| Provider Information | |||||||||
| NPI: | 1114295110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL OAK PEDIATRIC ASSOCIATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 RADIO HILL RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838183 | ||||||||
| FaxNumber: | 2767839267 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 RADIO HILL RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838183 | ||||||||
| FaxNumber: | 2767839267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2011 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | HENLEY | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2767838183 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.