Provider Demographics
NPI:1477585073
Name:UNION AVENUE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:UNION AVENUE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-759-3333
Mailing Address - Street 1:1530 S UNION AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1954
Mailing Address - Country:US
Mailing Address - Phone:253-759-3333
Mailing Address - Fax:253-759-1415
Practice Address - Street 1:1530 S UNION AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1954
Practice Address - Country:US
Practice Address - Phone:253-759-3333
Practice Address - Fax:253-759-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty