Healthcare Provider Details

I. General information

NPI: 1710299110
Provider Name (Legal Business Name): COLLEGEVILLE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 RIDGE PIKE
COLLEGEVILLE PA
19426-3170
US

IV. Provider business mailing address

3770 RIDGE PIKE
COLLEGEVILLE PA
19426-3170
US

V. Phone/Fax

Practice location:
  • Phone: 610-489-8130
  • Fax: 610-489-8136
Mailing address:
  • Phone: 610-489-8130
  • Fax: 610-489-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD040252E
License Number StatePA

VIII. Authorized Official

Name: KAREN L ALBANESE
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-489-8130