Provider Demographics
NPI:1417033986
Name:SOUTH COUNTY PEDIATRIC GROUP, INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY PEDIATRIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-789-6492
Mailing Address - Street 1:4979 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2283
Mailing Address - Country:US
Mailing Address - Phone:401-789-6492
Mailing Address - Fax:401-789-5524
Practice Address - Street 1:4979 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2283
Practice Address - Country:US
Practice Address - Phone:401-789-6492
Practice Address - Fax:401-789-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty