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NPI Code Detail

MEDICARE: PEDIATRIC ASSOCIATES PC

MEDICARE: PEDIATRIC ASSOCIATES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1194810127
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC ASSOCIATES PC
Provider Business Mailing Address
First Line : 7600 N 15TH ST
Second Line : #130
City : PHOENIX
State : AZ
Zip : 85020-4347
Country : US
Telephone Number : 602-861-1611
Fax Number : 602-371-8929
Provider Business Practice Location Address
First Line : 7600 N 15TH ST
Second Line : #130
City : PHOENIX
State : AZ
Zip : 85020-4347
Country : US
Telephone Number : 602-861-1611
Fax Number : 602-371-8929
Authorized Official
Title or Position : PRESIDENT
Name : DAVID RALPH LERSCH
Credential : MD
Telephone Number : 602-861-1611
Provider Enumeration Date : 10/04/2006
Last Update Date : 08/22/2020

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Directions to “PEDIATRIC ASSOCIATES PC ” Practice Location

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