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General NPI Number Information
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NPI Number | 1083490981
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ADOLESCENT MEDICINE OF CHESHIRE, LLC
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 677 S MAIN ST STE 4
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City | CHESHIRE
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State | CT
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Zip | 06410-3161
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Country | US
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Telephone | 203-272-2382
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Fax | 203-272-0071
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Provider Business Mailing Address
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Address Line | 677 S MAIN ST STE 4
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City | CHESHIRE
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State | CT
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Zip | 06410-3161
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Country | US
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Telephone | 203-272-2382
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Fax | 203-272-0071
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Authorized Official
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Title or Position | OWNER
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Name | JEANNETTE CHINCHILLA
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Credential | MD
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Telephone | 203-272-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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