Healthcare Provider Details

I. General information

NPI: 1861530776
Provider Name (Legal Business Name): TWICKENHAM PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MANNING DR SW SUITE A101
HUNTSVILLE AL
35801-4315
US

IV. Provider business mailing address

115 MANNING DR SW SUITE A101
HUNTSVILLE AL
35801-4315
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-1030
  • Fax: 256-533-1043
Mailing address:
  • Phone: 256-533-1030
  • Fax: 256-533-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MURIEL A DESIMONE
Title or Position: M.D.
Credential: MD
Phone: 256-533-1030