Provider Demographics
NPI:1841383239
Name:VALLEY PEDIATRICS PC
Entity Type:Organization
Organization Name:VALLEY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REFERRAL CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-918-5783
Mailing Address - Street 1:866 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2170
Mailing Address - Country:US
Mailing Address - Phone:215-293-6010
Mailing Address - Fax:215-293-6014
Practice Address - Street 1:866 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2170
Practice Address - Country:US
Practice Address - Phone:215-293-6010
Practice Address - Fax:215-293-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072275Medicare PIN