=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356583256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALLS PEDIATRIC & TEEN CARE, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 HENRY AVE ONE FALLS CENTER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-842-7415
-----------------------------------------------------
Fax | 215-848-1355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 HENRY AVE ONE FALLS CENTER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-842-7415
-----------------------------------------------------
Fax | 215-848-1355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | MARY DHAND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-842-7415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------