Provider Demographics
NPI:1235183658
Name:ACKROYD PEDIATRICS PC
Entity Type:Organization
Organization Name:ACKROYD 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:ALAN
Authorized Official - Last Name:ACKROYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-622-7533
Mailing Address - Street 1:831 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2921
Mailing Address - Country:US
Mailing Address - Phone:610-622-7533
Mailing Address - Fax:610-622-7693
Practice Address - Street 1:831 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2921
Practice Address - Country:US
Practice Address - Phone:610-622-7533
Practice Address - Fax:610-622-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 047071 L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016285280003Medicaid
PA0016285280003Medicaid