Provider Demographics
NPI:1376774778
Name:ROCHESTER PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:ROCHESTER PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-608-5858
Mailing Address - Street 1:110 SOUTH BLVD W
Mailing Address - Street 2:STE 101
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5184
Mailing Address - Country:US
Mailing Address - Phone:248-608-5858
Mailing Address - Fax:248-853-7717
Practice Address - Street 1:110 SOUTH BLVD W
Practice Address - Street 2:STE 101
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5184
Practice Address - Country:US
Practice Address - Phone:248-608-5858
Practice Address - Fax:248-853-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF16405Medicare UPIN