Provider Demographics
NPI:1659421857
Name:KIDS FIRST PEDIATRICS, PA
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-542-5540
Mailing Address - Street 1:8169 ARDREY KELL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5717
Mailing Address - Country:US
Mailing Address - Phone:704-542-5540
Mailing Address - Fax:704-542-5227
Practice Address - Street 1:8169 ARDREY KELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5717
Practice Address - Country:US
Practice Address - Phone:704-542-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty