Provider Demographics
NPI:1033287552
Name:ALL STAR PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ALL STAR PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-363-1330
Mailing Address - Street 1:702 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1253
Mailing Address - Country:US
Mailing Address - Phone:610-363-1330
Mailing Address - Fax:
Practice Address - Street 1:702 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1253
Practice Address - Country:US
Practice Address - Phone:610-363-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011937443002Medicaid