Provider Demographics
NPI:1346418357
Name:PEDIATRIC HEALTH PARTNERS PA
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANCAYCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-515-5414
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-2102
Mailing Address - Country:US
Mailing Address - Phone:301-515-5414
Mailing Address - Fax:301-515-5412
Practice Address - Street 1:20500 SENECA MEADOWS PKWY
Practice Address - Street 2:SUITE 2900
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7008
Practice Address - Country:US
Practice Address - Phone:301-515-5414
Practice Address - Fax:301-515-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty