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General NPI Number Information
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NPI Number | 1740310168
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PEDIATRICS
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | TRM PLAZA SUITE 203
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-4888
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Fax | 606-638-9003
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Provider Business Mailing Address
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Address Line | TRM PLAZA SUITE 203
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-4888
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Fax | 606-638-9003
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAN A FERRARA
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Credential | M.D.
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Telephone | 606-638-4888
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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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