Provider Demographics
NPI:1023652708
Name:PEDIATRIC CARE GROUP, P.C.
Entity type:Organization
Organization Name:PEDIATRIC CARE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-885-8700
Mailing Address - Street 1:261 OLD YORK RD STE 620
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3719
Mailing Address - Country:US
Mailing Address - Phone:215-885-8700
Mailing Address - Fax:
Practice Address - Street 1:890 2ND STREET PIKE STE 904
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1021
Practice Address - Country:US
Practice Address - Phone:215-515-8700
Practice Address - Fax:215-885-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty