Basic Information
| Provider Information | |||||||||
| NPI: | 1740244110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS COMMUNITY PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2790 MOSSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151462758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123809250 | ||||||||
| FaxNumber: | 4123809253 | ||||||||
| Practice Location | |||||||||
| Address1: | 2790 MOSSIDE BLVD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151462743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123809250 | ||||||||
| FaxNumber: | 4123809253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIVENS | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7249331100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.