Healthcare Provider Details

I. General information

NPI: 1609042647
Provider Name (Legal Business Name): CONTEMPORARY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 YANKEE PARK PL
CENTERVILLE OH
45458-1878
US

IV. Provider business mailing address

1516 YANKEE PARK PL
CENTERVILLE OH
45458-1878
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-1115
  • Fax: 937-424-4721
Mailing address:
  • Phone: 937-438-1115
  • Fax: 937-424-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34003507M
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT PAUL MYERS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 937-438-1115