Healthcare Provider Details

I. General information

NPI: 1083669055
Provider Name (Legal Business Name): GERMANTOWN PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PENN BLVD SUITE 103
PHILADELPHIA PA
19144-1416
US

IV. Provider business mailing address

2 PENN BLVD SUITE 103
PHILADELPHIA PA
19144-1416
US

V. Phone/Fax

Practice location:
  • Phone: 215-842-0406
  • Fax: 215-842-3215
Mailing address:
  • Phone: 215-842-0406
  • Fax: 215-842-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PASQUALE A MIGNANO
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 215-951-8786