Healthcare Provider Details

I. General information

NPI: 1356333926
Provider Name (Legal Business Name): CHILDRENS CHOICE PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 DARROW RD #105
STOW OH
44224-2600
US

IV. Provider business mailing address

3925 DARROW RD #105
STOW OH
44224-2600
US

V. Phone/Fax

Practice location:
  • Phone: 330-686-8424
  • Fax: 330-686-7810
Mailing address:
  • Phone: 330-686-8424
  • Fax: 330-686-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35060329
License Number StateOH

VIII. Authorized Official

Name: CAROLINE DH DOUGHERTY
Title or Position: PHYSICIAN
Credential: MD
Phone: 330-686-8424