Basic Information
| Provider Information | |||||||||
| NPI: | 1205076122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PANORAMA PEDIATRIC GROUP, RLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 LINDEN OAKS STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853814982 | ||||||||
| FaxNumber: | 5853811821 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 LINDEN OAKS STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853814982 | ||||||||
| FaxNumber: | 5853811821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | LUDWIG | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5853814982 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F381534-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.