Provider Demographics
NPI:1275617474
Name:WASHINGTON PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:WASHINGTON PHYSICIAN SERVICES
Other - Org Name:WATERDAM PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-229-1756
Mailing Address - Street 1:2001 WATERDAM PLAZA DR
Mailing Address - Street 2:STE 105
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5416
Mailing Address - Country:US
Mailing Address - Phone:724-942-6499
Mailing Address - Fax:724-942-6498
Practice Address - Street 1:2001 WATERDAM PLAZA DR
Practice Address - Street 2:STE 105
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5416
Practice Address - Country:US
Practice Address - Phone:724-942-6499
Practice Address - Fax:724-942-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015918490027Medicaid