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General NPI Number Information
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NPI Number | 1194134304
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Entity Type | Organization
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Legal Business Name | PEDIATRICS 21, LLC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 670 N RIVER ST STE 270
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City | PLAINS
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State | PA
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Zip | 18705
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Country | US
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Telephone | 570-270-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 670 N RIVER ST STE 270
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City | PLAINS
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State | PA
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Zip | 18705-1027
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Country | US
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Telephone | 570-270-2525
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Fax |
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Authorized Official
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Title or Position | OWNER,PHYSICIAN
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Name | DR. AZRA M SEHIC
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Credential | M.D.
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Telephone | 570-270-2525
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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 | MD065674L
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License Number State | PA
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