Provider Demographics
NPI:1477626125
Name:PEDIATRIC ASSOCIATES, INC., P.S. DBA ALLEGRO PEDIATRICS
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES, INC., P.S. DBA ALLEGRO PEDIATRICS
Other - Org Name:PINE LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-460-5643
Mailing Address - Street 1:2475 140TH AVE. NE. BUILDING C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-460-5601
Mailing Address - Fax:425-460-5606
Practice Address - Street 1:1011 NE HIGH STREET
Practice Address - Street 2:SUITE #200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-391-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty