Provider Demographics
NPI:1467891531
Name:LONGWOOD PEDIATRICS, LLC
Entity Type:Organization
Organization Name:LONGWOOD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:UBHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-9970
Mailing Address - Street 1:1400 W STATE ROAD 434 STE 1010
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3817
Mailing Address - Country:US
Mailing Address - Phone:407-644-9970
Mailing Address - Fax:407-644-6926
Practice Address - Street 1:1400 W STATE ROAD 434 STE 1010
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:407-644-9970
Practice Address - Fax:407-644-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty