Provider Demographics
NPI:1205860061
Name:CHESTER COUNTY PEDIATRICS PC
Entity Type:Organization
Organization Name:CHESTER COUNTY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-873-5437
Mailing Address - Street 1:915 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311
Mailing Address - Country:US
Mailing Address - Phone:610-268-2752
Mailing Address - Fax:610-268-5364
Practice Address - Street 1:915 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311
Practice Address - Country:US
Practice Address - Phone:610-268-2752
Practice Address - Fax:610-268-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017249540006Medicaid