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General NPI Number Information
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NPI Number | 1629076716
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PARTNERS OF JEFFERSONTOWN
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3840 RUCKRIEGEL PKWY STE105
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City | LOUISVILLE
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State | KY
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Zip | 40299-3986
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Country | US
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Telephone | 502-261-7227
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Fax | 502-261-7157
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Provider Business Mailing Address
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Address Line | 3840 RUCKRIEGEL PKWY STE105
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City | LOUISVILLE
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State | KY
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Zip | 40299-6835
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Country | US
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Telephone | 502-261-7227
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Fax | 844-965-9615
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOSEPH CHARLES PAPPALARDO
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Credential | M.D.
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Telephone | 502-261-7227
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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 | KY
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