| NPI | 1417053794 |
|---|---|
| Other Name | LAKE RIDGE OFFICE |
| Entity Type | Organization |
| Authorized Contact | DEBORAH WEESE Practice Administrator 703-212-6600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |