Healthcare Provider Details

I. General information

NPI: 1962554394
Provider Name (Legal Business Name): PEDIATRIC CARE OF EXTON, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N POTTSTOWN PIKE SUITE 205
EXTON PA
19341-2218
US

IV. Provider business mailing address

319 N POTTSTOWN PIKE SUITE 205
EXTON PA
19341-2218
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-7700
  • Fax: 610-280-7593
Mailing address:
  • Phone: 610-280-7700
  • Fax: 610-280-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD056957L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. THOMAS KALKIEWICZ JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-280-7700