Provider Demographics
NPI:1851773584
Name:PLYMOUTH PEDIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PLYMOUTH PEDIATRIC ASSOCIATES, LLC
Other - Org Name:PLYMOUTH PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-747-5900
Mailing Address - Street 1:139 SANDWICH ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2449
Mailing Address - Country:US
Mailing Address - Phone:508-747-5900
Mailing Address - Fax:508-747-2290
Practice Address - Street 1:148 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-747-5900
Practice Address - Fax:508-747-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty