Provider Demographics
NPI:1033120365
Name:COLONIAL PARK PEDIATRICS ASSOCIATES
Entity Type:Organization
Organization Name:COLONIAL PARK PEDIATRICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-652-8001
Mailing Address - Street 1:2205 FOREST HILLS DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1001
Mailing Address - Country:US
Mailing Address - Phone:717-652-8001
Mailing Address - Fax:717-540-9757
Practice Address - Street 1:2205 FOREST HILLS DR
Practice Address - Street 2:SUITE 12
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1001
Practice Address - Country:US
Practice Address - Phone:717-652-8001
Practice Address - Fax:717-540-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000937832004Medicaid