Provider Demographics
NPI:1134274277
Name:EAST SUBURBAN PEDIATRIC ASSOCIATES LTD
Entity type:Organization
Organization Name:EAST SUBURBAN PEDIATRIC ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-325-2133
Mailing Address - Street 1:4262 OLD WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1936
Mailing Address - Country:US
Mailing Address - Phone:724-325-2133
Mailing Address - Fax:724-733-2278
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1936
Practice Address - Country:US
Practice Address - Phone:724-325-2133
Practice Address - Fax:724-733-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty