Provider Demographics
NPI:1437696093
Name:FISHER-TITUS PEDIATRICS LLC
Entity Type:Organization
Organization Name:FISHER-TITUS PEDIATRICS LLC
Other - Org Name:NEW BEGINNINGS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-660-6931
Mailing Address - Street 1:282 BENEDICT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2712
Mailing Address - Country:US
Mailing Address - Phone:419-668-9409
Mailing Address - Fax:
Practice Address - Street 1:282 BENEDICT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2712
Practice Address - Country:US
Practice Address - Phone:419-668-9409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISHER-TITUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty