Provider Demographics
NPI:1013158591
Name:CROSSWOODS PEDIATRICS
Entity Type:Organization
Organization Name:CROSSWOODS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-540-7339
Mailing Address - Street 1:760 LAKEVIEW PLAZA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-540-7339
Mailing Address - Fax:614-540-7338
Practice Address - Street 1:760 LAKEVIEW PLAZA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4734
Practice Address - Country:US
Practice Address - Phone:614-540-7339
Practice Address - Fax:614-540-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058655173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty