Healthcare Provider Details

I. General information

NPI: 1578640371
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

3410 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-7817
  • Fax: 505-266-1543
Mailing address:
  • Phone: 505-265-7817
  • Fax: 505-266-1543

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. GRETCHEN ELAINE SEELINGER
Title or Position: OWNER
Credential: M.D.
Phone: 505-265-7817