Provider Demographics
NPI:1821137415
Name:POCONO PEDIATRIC ASSOCIATES INC
Entity Type:Organization
Organization Name:POCONO PEDIATRIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-223-5010
Mailing Address - Street 1:9090 FRANKLIN HILL ROAD
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9103
Mailing Address - Country:US
Mailing Address - Phone:570-223-5010
Mailing Address - Fax:570-223-5015
Practice Address - Street 1:9090 FRANKLIN HILL ROAD
Practice Address - Street 2:SUITE 2021
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9103
Practice Address - Country:US
Practice Address - Phone:570-223-5010
Practice Address - Fax:570-223-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007455040002Medicaid
PA1007455040007Medicaid