Provider Demographics
NPI:1437173523
Name:SOUTHAMPTON PEDIATRICS
Entity Type:Organization
Organization Name:SOUTHAMPTON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-953-1020
Mailing Address - Street 1:207 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-953-1020
Mailing Address - Fax:
Practice Address - Street 1:207 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-953-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty