Provider Demographics
NPI:1659585149
Name:SOUTHINGTON PEDIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHINGTON PEDIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER OF PRACTICE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARVINKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-621-8331
Mailing Address - Street 1:209 MAIN ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-621-8331
Mailing Address - Fax:860-621-5169
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-621-8331
Practice Address - Fax:860-621-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty