Provider Demographics
NPI:1073639258
Name:PEDIATRIC PARTNERS,P.C.
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-627-1133
Mailing Address - Street 1:1575 HIGHLANDS DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7507
Mailing Address - Country:US
Mailing Address - Phone:717-627-1133
Mailing Address - Fax:717-627-3762
Practice Address - Street 1:1575 HIGHLANDS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7507
Practice Address - Country:US
Practice Address - Phone:717-627-1133
Practice Address - Fax:717-627-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025637E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID
PAE53741Medicare UPIN