Provider Demographics
NPI:1821153180
Name:PEDIATRIC HEALTH CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KANAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-535-1110
Mailing Address - Street 1:10 CENTENNIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-535-1110
Mailing Address - Fax:978-535-2907
Practice Address - Street 1:10 CENTENNIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-535-1110
Practice Address - Fax:978-535-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty