Provider Demographics
NPI:1134300767
Name:NORTH CARROLLTON PEDIATRIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NORTH CARROLLTON PEDIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-492-4242
Mailing Address - Street 1:4443 N JOSEY LN STE 160
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4676
Mailing Address - Country:US
Mailing Address - Phone:972-492-4242
Mailing Address - Fax:972-394-1282
Practice Address - Street 1:4443 N JOSEY LN STE 160
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4676
Practice Address - Country:US
Practice Address - Phone:972-492-4242
Practice Address - Fax:972-394-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty