Provider Demographics
NPI:1225107261
Name:CANTON PEDIATRICS
Entity Type:Organization
Organization Name:CANTON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAIL
Authorized Official - Prefix:DR
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGHUNATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-455-0800
Mailing Address - Street 1:6231 CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2694
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:
Practice Address - Street 1:6231 CNATON CENTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-459-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty