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General NPI Number Information
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NPI Number | 1083822480
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Entity Type | Organization
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Legal Business Name | DOCTORS PEDIATRIC PC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 55 DANBURY RD
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City | WILTON
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State | CT
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Zip | 06897-4405
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Country | US
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Telephone | 203-762-3363
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Fax | 203-762-1999
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Provider Business Mailing Address
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Address Line | 55 DANBURY RD
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City | WILTON
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State | CT
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Zip | 06897-4405
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Country | US
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Telephone | 203-762-3363
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Fax | 203-762-1999
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Authorized Official
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Title or Position | ADMIN
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Name | DR. CHRISTINE MACKEN
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Credential | MD
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Telephone | 203-762-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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