Healthcare Provider Details

I. General information

NPI: 1235166166
Provider Name (Legal Business Name): WASSERMAN PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1025
US

IV. Provider business mailing address

5844 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1025
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-2002
  • Fax: 407-578-2277
Mailing address:
  • Phone: 407-578-2002
  • Fax: 407-578-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0053446
License Number StateFL

VIII. Authorized Official

Name: DR. LEWIS C WASSERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-578-2002