Healthcare Provider Details

I. General information

NPI: 1730516659
Provider Name (Legal Business Name): MT. AIRY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6673 GERMANTOWN AVE
PHILADELPHIA PA
19119-2252
US

IV. Provider business mailing address

6673 GERMANTOWN AVE
PHILADELPHIA PA
19119-2252
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-2996
  • Fax: 215-247-7504
Mailing address:
  • Phone: 215-247-2996
  • Fax: 215-247-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER LOUIS JADOTTE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 215-247-2996