Provider Demographics
NPI:1578542205
Name:THE CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:THE CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PILLSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-678-8333
Mailing Address - Street 1:125-1 GREENTREE DROVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-678-8333
Mailing Address - Fax:302-674-2298
Practice Address - Street 1:125-1 GREENTREE DROVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-678-8333
Practice Address - Fax:302-674-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00634Medicare ID - Type Unspecified