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General NPI Number Information
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NPI Number | 1457870313
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Entity Type | Organization
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Legal Business Name | PEDIATRICS OF CAMBRIDGE INC.
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1432 CLARK ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-8745
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Country | US
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Telephone | 740-439-6664
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Fax | 740-439-8664
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Provider Business Mailing Address
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Address Line | 1432 CLARK ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-8745
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Country | US
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Telephone | 740-439-6664
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Fax | 740-439-8664
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. SHOBHA U LALL
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Credential | MD
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Telephone | 740-439-6664
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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 | 35-039646
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License Number State | OH
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