Provider Demographics
NPI:1457837171
Name:WADLEY PEDIATRICS, PA
Entity Type:Organization
Organization Name:WADLEY PEDIATRICS, PA
Other - Org Name:127 PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-253-7596
Mailing Address - Street 1:33 MAIN ST STE 160
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2982
Mailing Address - Country:US
Mailing Address - Phone:817-476-0675
Mailing Address - Fax:817-207-4185
Practice Address - Street 1:33 MAIN ST STE 160
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2982
Practice Address - Country:US
Practice Address - Phone:817-476-0675
Practice Address - Fax:817-207-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty