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NPI Code Detail

MEDICARE: PEDIATRIC PULMONARY ASSOCIATES P.A.

MEDICARE: PEDIATRIC PULMONARY ASSOCIATES P.A.
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
12080P0214XPediatric Pulmonology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518948488
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC PULMONARY ASSOCIATES P.A.
Provider Business Mailing Address
First Line : 100 PENN SQUARE EAST
Second Line : 9TH FLOOR NORTH TOWER
City : PHILADELPHIA
State : PA
Zip : 19107
Country : US
Telephone Number : 267-425-9200
Fax Number : 267-425-9299
Provider Business Practice Location Address
First Line : 3401 CIVIC CENTER BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4319
Country : US
Telephone Number : 215-590-1000
Fax Number : 215-590-3500
Authorized Official
Title or Position : PRESIDENT PEDIATRIC PULMONARY ASSOC
Name : DR. JEFFREY EWIG
Credential : M.D.
Telephone Number : 727-767-4146
Provider Enumeration Date : 11/08/2005
Last Update Date : 11/26/2018

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1407800220 — DR. SUZANNE E BECK M.D.
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1417970450 — OSCAR H MAYER M.D.
Practice Location Address:
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1326061367 — ROBERT W MILLER M.D.
Practice Location Address:
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Practice Fax: 215-590-3500

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