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General NPI Number Information
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NPI Number | 1629784194
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Entity Type | Organization
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Legal Business Name | NORTHSIDE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 1200 JUPITER RD # 940683
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City | PLANO
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State | TX
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Zip | 75074-7017
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Country | US
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Telephone | 682-305-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 317 W MUIRFIELD RD
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City | GARLAND
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State | TX
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Zip | 75044-4233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JAEON ABRAHAM
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Credential | MD
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Telephone | 214-674-9189
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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 |
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