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General NPI Number Information
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NPI Number | 1669723409
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Entity Type | Organization
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Legal Business Name | COMMUNITY PEDIATRICS, INC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 3966 BROWN PARK DRIVE, SUITE C
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City | HILLIARD
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State | OH
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Zip | 43026-1164
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Country | US
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Telephone | 614-876-1304
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Fax | 614-876-6844
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Provider Business Mailing Address
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Address Line | 3966 BROWN PARK DRIVE, SUITE C
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City | HILLIARD
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State | OH
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Zip | 43026-1164
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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 | PRESIDENT
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Name | DR. ENAAS F KASHEER
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Credential |
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Telephone | 614-876-1304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 076356
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License Number State | OH
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