Provider Demographics
NPI:1346369279
Name:HAZLETON CHILDREN'S MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:HAZLETON CHILDREN'S MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-455-7823
Mailing Address - Street 1:1730 E BROAD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5622
Mailing Address - Country:US
Mailing Address - Phone:570-455-7823
Mailing Address - Fax:570-455-8848
Practice Address - Street 1:1730 E BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5622
Practice Address - Country:US
Practice Address - Phone:570-455-7823
Practice Address - Fax:570-455-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015718460001Medicaid