Provider Demographics
NPI:1598887713
Name:PEDIATRIC & ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-326-1600
Mailing Address - Street 1:5072 REED RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2514
Mailing Address - Country:US
Mailing Address - Phone:614-326-1600
Mailing Address - Fax:614-326-3600
Practice Address - Street 1:5072 REED RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2514
Practice Address - Country:US
Practice Address - Phone:614-326-1600
Practice Address - Fax:614-326-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty