Provider Demographics
NPI:1073950234
Name:PEDIATRIC MEDICAL CENTER OF LEHIGH VALLEY, INC.
Entity Type:Organization
Organization Name:PEDIATRIC MEDICAL CENTER OF LEHIGH VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:KADEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-252-3042
Mailing Address - Street 1:1922 HAY TER
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4615
Mailing Address - Country:US
Mailing Address - Phone:610-252-3042
Mailing Address - Fax:610-253-0831
Practice Address - Street 1:1922 HAY TER
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4615
Practice Address - Country:US
Practice Address - Phone:610-252-3042
Practice Address - Fax:610-253-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069173L2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017715600001Medicaid