Provider Demographics
NPI:1093845893
Name:ABC PEDIATRICS OF OHIO, LLC
Entity Type:Organization
Organization Name:ABC PEDIATRICS OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:FITTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-335-0886
Mailing Address - Street 1:1510 COLUMBUS AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1899
Mailing Address - Country:US
Mailing Address - Phone:740-335-0886
Mailing Address - Fax:740-335-1924
Practice Address - Street 1:1510 COLUMBUS AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1899
Practice Address - Country:US
Practice Address - Phone:740-335-0886
Practice Address - Fax:740-335-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340059892080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216368Medicaid
OHH49535Medicare UPIN
OHFI4060701Medicare ID - Type Unspecified