=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427157015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEE CARE PEDIATRICS GROUP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2860 3RD AVE SUITE 30
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25702-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-399-5437
-----------------------------------------------------
Fax | 304-399-1104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2860 3RD AVE SUITE 30
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25702-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-399-5437
-----------------------------------------------------
Fax | 304-399-1104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHARON M DICRISTOFARO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 304-399-5437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2101
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------