Provider Demographics
NPI:1073603999
Name:MAUMEE PEDIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MAUMEE PEDIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-893-1880
Mailing Address - Street 1:520 W SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1848
Mailing Address - Country:US
Mailing Address - Phone:419-893-1880
Mailing Address - Fax:419-893-1242
Practice Address - Street 1:520 W SOPHIA ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1848
Practice Address - Country:US
Practice Address - Phone:419-893-1880
Practice Address - Fax:419-893-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35972439-O208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty