Healthcare Provider Details

I. General information

NPI: 1518948488
Provider Name (Legal Business Name): PEDIATRIC PULMONARY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 PENN SQUARE EAST 9TH FLOOR NORTH TOWER
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 215-590-3500
Mailing address:
  • Phone: 267-425-9200
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY EWIG
Title or Position: PRESIDENT PEDIATRIC PULMONARY ASSOC
Credential: M.D.
Phone: 727-767-4146