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General NPI Number Information
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NPI Number | 1336328046
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MD SERVICES, LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/21/2008
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE SUITE 109
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-736-2510
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Fax | 561-503-4873
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Provider Business Mailing Address
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Address Line | 1325 S CONGRESS AVE SUITE 109
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-736-2510
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Fax | 561-503-4873
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SUZANNE PAVLOU
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Credential | MD
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Telephone | 561-736-2510
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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 | ME90011
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License Number State | FL
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