MEDICARE: WYOMING PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	AC6919471	PA

General Provider Information

NPI Number	:	1508922055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING PEDIATRICS

Provider Business Mailing Address
First Line	:	1331 E WYOMING AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-3808
Country	:	US
Telephone Number	:	215-743-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 E WYOMING AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-3808
Country	:	US
Telephone Number	:	215-743-4326
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	DR. STEWART COOLER
Credential	:	MD
Telephone Number	:	215-743-4326

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/10/2008

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