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General NPI Number Information
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NPI Number | 1245353895
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF ORLANDO, PA
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 414 N MILLS AVE
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City | ORLANDO
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State | FL
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Zip | 32803-5761
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Country | US
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Telephone | 407-841-7296
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Fax | 407-872-3913
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Provider Business Mailing Address
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Address Line | 414 N MILLS AVE
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City | ORLANDO
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State | FL
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Zip | 32803-5761
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Country | US
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Telephone | 407-841-7296
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Fax | 407-872-3913
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Authorized Official
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Title or Position | PHYSICIAN, OWNER
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Name | MARK B DIDEA
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Credential | MD
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Telephone | 407-841-7296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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