Provider Demographics
NPI:1659575298
Name:ALL GOD'S CHILDREN
Entity Type:Organization
Organization Name:ALL GOD'S CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEIDENHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-453-0568
Mailing Address - Street 1:626 W NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-2005
Mailing Address - Country:US
Mailing Address - Phone:724-453-0568
Mailing Address - Fax:
Practice Address - Street 1:626 W NEW CASTLE ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-2005
Practice Address - Country:US
Practice Address - Phone:724-453-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038036E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012033300005Medicaid
PA993771OtherHIGHMARK BC BS