Healthcare Provider Details

I. General information

NPI: 1457346090
Provider Name (Legal Business Name): PEDIATRIC ASSOICATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 DILEY ROAD SUITE A
CANAL WINCHESTER OH
43110-7758
US

IV. Provider business mailing address

7750 DILEY ROAD SUITE A
CANAL WINCHESTER OH
43110-7758
US

V. Phone/Fax

Practice location:
  • Phone: 614-837-7337
  • Fax: 614-837-7335
Mailing address:
  • Phone: 614-837-7337
  • Fax: 614-837-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM W LONG
Title or Position: OWNER
Credential: M.D
Phone: 614-837-7337