Provider Demographics
NPI:1568239861
Name:PENN PEDIATRICS LLC
Entity Type:Organization
Organization Name:PENN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-296-9344
Mailing Address - Street 1:260 SW NATURA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3026
Mailing Address - Country:US
Mailing Address - Phone:954-505-8524
Mailing Address - Fax:
Practice Address - Street 1:260 SW NATURA AVE STE 102
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3026
Practice Address - Country:US
Practice Address - Phone:954-505-8524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty