Provider Demographics
NPI:1013238492
Name:PEDIATRIC ASTHMA ALLERGY SPECIALTY CARE CENTER
Entity Type:Organization
Organization Name:PEDIATRIC ASTHMA ALLERGY SPECIALTY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALLERGY IMMUNOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:TRONG
Authorized Official - Middle Name:V
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-943-3224
Mailing Address - Street 1:225 S CHESTER RD
Mailing Address - Street 2:STE #7
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1919
Mailing Address - Country:US
Mailing Address - Phone:610-943-3224
Mailing Address - Fax:610-943-2344
Practice Address - Street 1:221 MARTROY LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6313
Practice Address - Country:US
Practice Address - Phone:610-945-5785
Practice Address - Fax:610-943-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432871207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102020613Medicaid
PA102020613Medicaid