Provider Demographics
NPI:1205440401
Name:PANDA PEDIATRICS LLC
Entity type:Organization
Organization Name:PANDA PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-807-8988
Mailing Address - Street 1:3635 QUAKERBRIDGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1247
Mailing Address - Country:US
Mailing Address - Phone:609-807-8988
Mailing Address - Fax:
Practice Address - Street 1:3635 QUAKERBRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1247
Practice Address - Country:US
Practice Address - Phone:609-807-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty