Healthcare Provider Details

I. General information

NPI: 1790727295
Provider Name (Legal Business Name): MT AIRY PEDIATRICS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 GERMANTOWN AVE
PHILADELPHIA PA
19119-1826
US

IV. Provider business mailing address

7056 GERMANTOWN AVE
PHILADELPHIA PA
19119-1826
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: DR. HERBERT M. CADY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 215-247-2996