Healthcare Provider Details

I. General information

NPI: 1578542205
Provider Name (Legal Business Name): THE CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125-1 GREENTREE DROVE
DOVER DE
19904
US

IV. Provider business mailing address

125-1 GREENTREE DROVE
DOVER DE
19904
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-8333
  • Fax: 302-674-2298
Mailing address:
  • Phone: 302-678-8333
  • Fax: 302-674-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIA M PILLSBURY
Title or Position: OWNER/CEO/PRESIDENT
Credential: D.O.
Phone: 302-678-8333