Healthcare Provider Details

I. General information

NPI: 1326194648
Provider Name (Legal Business Name): ROBERT WILLIAM CHILDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEHIGH VALLEY PHYSICIAN BUSINESS SERVICES 1650 VALLEY CENTER PARKWAY, SUITE 100
BETHLEHEM PA
18017-3234
US

IV. Provider business mailing address

PEDIATRIC ASSOCIATES OF HAZLETON 1000 ALLIANCE DRIVE
HAZLETON PA
18202-3234
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-4436
  • Fax: 484-884-7367
Mailing address:
  • Phone: 570-501-6400
  • Fax: 570-453-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-014506-E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0005875560006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier170494
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLU CROSS BLUE SHIELD
# 3
Identifier558825
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 4
Identifier12004
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 5
Identifier003004
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 6
IdentifierP3287365
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerOXFORD
# 7
Identifier81001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: