Provider Demographics
NPI:1235823691
Name:PEDIATRIC MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PEDIATRIC MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-947-5901
Mailing Address - Street 1:836 PAUL STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-342-1896
Mailing Address - Fax:407-369-4279
Practice Address - Street 1:836 PAUL STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808
Practice Address - Country:US
Practice Address - Phone:407-342-1896
Practice Address - Fax:407-369-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty