Provider Demographics
NPI:1497023337
Name:CAROLINA PEDIATRIC GROUP CORP
Entity Type:Organization
Organization Name:CAROLINA PEDIATRIC GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-257-0709
Mailing Address - Street 1:PO BOX 3628
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3628
Mailing Address - Country:US
Mailing Address - Phone:787-257-0709
Mailing Address - Fax:787-276-4228
Practice Address - Street 1:AVE ROBERTO CLEMENTE BLOQ 132 #11
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-257-0709
Practice Address - Fax:787-276-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty