Provider Demographics
NPI:1497831218
Name:PEDIATRIC ASSOCIATES INC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-248-4636
Mailing Address - Street 1:34501 AURORA ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3873
Mailing Address - Country:US
Mailing Address - Phone:440-248-4636
Mailing Address - Fax:440-248-0133
Practice Address - Street 1:34501 AURORA ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-248-4636
Practice Address - Fax:440-248-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216939Medicaid