| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Surgery |
| DEFINITION | A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| AREA OF SPECIALIZATION | Pediatric Surgery |
| STATUS | Active |
| VA CODE | V183101 |
| X12 CODE | 2086S0120X |
| SPECIALTY CODE | 02 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251403 |
| EFFECTIVE DATE/TIME |
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