Provider Demographics
NPI:1578504288
Name:NORTHEAST PEDIATRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NORTHEAST PEDIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-856-6300
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5820
Mailing Address - Country:US
Mailing Address - Phone:248-856-6300
Mailing Address - Fax:248-856-6303
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-856-6300
Practice Address - Fax:248-856-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISA078409OtherSTATE LICENSE
MITS039701OtherSTATE LICENSE
MISL068132OtherSTATE LICENSE
MIAC032605OtherSTATE LICENSE
MIKH074131OtherSTATE LICENSE
MITS039701OtherSTATE LICENSE
MIH05452Medicare UPIN
MIA77214Medicare UPIN
MION50260Medicare UPIN