Provider Demographics
NPI:1013081223
Name:PEDIATRIC HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOLLESE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-753-1918
Mailing Address - Street 1:4815 GRANDVIEW PLACE
Mailing Address - Street 2:
Mailing Address - City:LAPLATA
Mailing Address - State:MA
Mailing Address - Zip Code:20646-2846
Mailing Address - Country:US
Mailing Address - Phone:301-753-1918
Mailing Address - Fax:301-392-0892
Practice Address - Street 1:404 EAST CHARLES STREET
Practice Address - Street 2:
Practice Address - City:LAPLATA
Practice Address - State:MA
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-751-6058
Practice Address - Fax:301-392-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty