Provider Demographics
NPI:1407955123
Name:TROY PEDIATRICS INC
Entity Type:Organization
Organization Name:TROY PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TROY PEDIATRICS INC
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:IRINGAN
Authorized Official - Last Name:PATTUGALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-1806
Mailing Address - Street 1:1405 STONYCREEK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373
Mailing Address - Country:US
Mailing Address - Phone:937-335-1806
Mailing Address - Fax:937-335-1749
Practice Address - Street 1:1405 STONYCREEK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-335-1806
Practice Address - Fax:937-335-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0913560Medicaid
OH0913560Medicaid
PA0628981Medicare ID - Type Unspecified