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General NPI Number Information
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NPI Number | 1518948488
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PULMONARY ASSOCIATES P.A.
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-1000
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Fax | 215-590-3500
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Provider Business Mailing Address
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Address Line | 100 PENN SQUARE EAST 9TH FLOOR NORTH TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 267-425-9200
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Fax | 267-425-9299
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Authorized Official
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Title or Position | PRESIDENT PEDIATRIC PULMONARY ASSOC
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Name | DR. JEFFREY EWIG
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Credential | M.D.
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Telephone | 727-767-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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