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NPI Code Detail

MEDICARE: PEDIATRIC MEDICAL ASSOCIATES, LLC.

MEDICARE: PEDIATRIC MEDICAL ASSOCIATES, LLC.
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
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1700213485
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC MEDICAL ASSOCIATES, LLC.
Provider Business Mailing Address
First Line : PO BOX 542590
Second Line :
City : GREENACRES
State : FL
Zip : 33454-2590
Country : US
Telephone Number : 800-990-0340
Fax Number :
Provider Business Practice Location Address
First Line : 4445 PINE FOREST DR
Second Line :
City : LAKE WORTH
State : FL
Zip : 33463-4676
Country : US
Telephone Number : 800-990-0340
Fax Number :
Authorized Official
Title or Position : CFO
Name : TODD BRANSTETTER
Credential :
Telephone Number : 800-990-0340
Provider Enumeration Date : 09/26/2013
Last Update Date : 02/26/2014

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