MEDICARE: CHILDRENS COMMUNITY 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

General Provider Information

NPI Number	:	1740244110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS COMMUNITY PEDIATRICS

Provider Business Mailing Address
First Line	:	103 BRADFORD RD STE 200
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-6910
Country	:	US
Telephone Number	:	724-933-1100
Fax Number	:	724-933-1160

Provider Business Practice Location Address
First Line	:	2790 MOSSIDE BLVD
Second Line	:	SUITE 700
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2743
Country	:	US
Telephone Number	:	412-380-9250
Fax Number	:	412-380-9253

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR III
Name	:	LORI MARTINEZ
Credential	:
Telephone Number	:	724-933-1100

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/13/2023

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