Basic Information
| Provider Information | |||||||||
| NPI: | 1477692887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESTON PEDIATRIC ASSOCIATES, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 PIDGEON HILL DR | ||||||||
| Address2: | SUITE 170,180 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201656146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034508660 | ||||||||
| FaxNumber: | 7034040275 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 PIDGEON HILL DR | ||||||||
| Address2: | SUITE 170,180 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201656146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034508660 | ||||||||
| FaxNumber: | 7034040275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANN | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7034508660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.