Provider Demographics
NPI:1467539841
Name:HOMETOWN PEDIATRICS, PA
Entity Type:Organization
Organization Name:HOMETOWN PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWALD
Authorized Official - Suffix:
Authorized Official - Credentials:CPPM
Authorized Official - Phone:281-292-8980
Mailing Address - Street 1:1595 LAKE FRONT CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3604
Mailing Address - Country:US
Mailing Address - Phone:281-292-8980
Mailing Address - Fax:281-292-8070
Practice Address - Street 1:1595 LAKE FRONT CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3604
Practice Address - Country:US
Practice Address - Phone:281-292-8980
Practice Address - Fax:281-292-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty