Provider Demographics
NPI:1174682363
Name:LONDON PEDIATRICS, INC.
Entity Type:Organization
Organization Name:LONDON PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GEIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-845-7650
Mailing Address - Street 1:55 PARK AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1121
Mailing Address - Country:US
Mailing Address - Phone:740-845-7650
Mailing Address - Fax:740-845-7651
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:STE 240
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1121
Practice Address - Country:US
Practice Address - Phone:740-845-7650
Practice Address - Fax:740-845-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2171742Medicaid