Provider Demographics
NPI:1629144167
Name:WINSTON PEDIATRICS PA
Entity Type:Organization
Organization Name:WINSTON PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-424-1650
Mailing Address - Street 1:375 MULLET RUN STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-424-1650
Mailing Address - Fax:302-422-7781
Practice Address - Street 1:375 MULLET RUN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-424-1650
Practice Address - Fax:302-422-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1004093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000482601Medicaid
DE0000482601Medicaid