Provider Demographics
NPI:1891184271
Name:DC PEDIATRICS INC
Entity Type:Organization
Organization Name:DC PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISPIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-578-8600
Mailing Address - Street 1:1603 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6438
Mailing Address - Country:US
Mailing Address - Phone:407-578-8600
Mailing Address - Fax:
Practice Address - Street 1:1603 S HIAWASSEE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6438
Practice Address - Country:US
Practice Address - Phone:407-578-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003372600Medicaid