Healthcare Provider Details

I. General information

NPI: 1184724320
Provider Name (Legal Business Name): SPRINGBORO PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SYCAMORE CREEK DR
SPRINGBORO OH
45066-2300
US

IV. Provider business mailing address

8 SYCAMORE CREEK DR
SPRINGBORO OH
45066-2300
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-5437
  • Fax: 937-748-5434
Mailing address:
  • Phone: 937-748-5437
  • Fax: 937-748-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0744378
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. BRIAN ESSELSTEIN
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 937-748-5437