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General NPI Number Information
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NPI Number | 1457346090
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOICATES, INC.
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 7750 DILEY ROAD SUITE A
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-7758
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Country | US
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Telephone | 614-837-7337
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Fax | 614-837-7335
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Provider Business Mailing Address
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Address Line | 7750 DILEY ROAD SUITE A
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-7758
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Country | US
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Telephone | 614-837-7337
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Fax | 614-837-7335
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM W LONG
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Credential | M.D
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Telephone | 614-837-7337
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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 |
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License Number State | OH
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