Provider Demographics
NPI:1568805059
Name:PEDIATRIC PARTNERS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-286-0444
Mailing Address - Street 1:705 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2479
Mailing Address - Country:US
Mailing Address - Phone:860-286-0444
Mailing Address - Fax:860-286-0464
Practice Address - Street 1:705 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2479
Practice Address - Country:US
Practice Address - Phone:860-286-0444
Practice Address - Fax:860-286-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0420012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAX ID