Provider Demographics
NPI:1659439891
Name:WAREHAM PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:WAREHAM PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-295-8622
Mailing Address - Street 1:53 MARION ROAD SUITE ONE
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571
Mailing Address - Country:US
Mailing Address - Phone:508-295-8622
Mailing Address - Fax:508-295-4909
Practice Address - Street 1:53 MARION ROAD SUITE ONE
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-295-8622
Practice Address - Fax:508-295-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty