Provider Demographics
NPI:1033321740
Name:C & M PEDIATRIC ASSOCIATES P A
Entity Type:Organization
Organization Name:C & M PEDIATRIC ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-641-3364
Mailing Address - Street 1:929 W PIONEER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4734
Mailing Address - Country:US
Mailing Address - Phone:972-641-3364
Mailing Address - Fax:972-641-3369
Practice Address - Street 1:929 W PIONEER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4734
Practice Address - Country:US
Practice Address - Phone:972-641-3364
Practice Address - Fax:972-641-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty