Provider Demographics
NPI:1477590263
Name:PEDIATRIC ASSOCIATES OF PLYMOUTH INC.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF PLYMOUTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-825-3502
Mailing Address - Street 1:3031 WALTON RD
Mailing Address - Street 2:C101
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2369
Mailing Address - Country:US
Mailing Address - Phone:610-825-3502
Mailing Address - Fax:610-825-8502
Practice Address - Street 1:3031 WALTON RD
Practice Address - Street 2:C101
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2369
Practice Address - Country:US
Practice Address - Phone:610-825-3502
Practice Address - Fax:610-825-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty