Provider Demographics
NPI:1205956497
Name:WADSWORTH PEDIATRICS, INC
Entity type:Organization
Organization Name:WADSWORTH PEDIATRICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OEHLENSCHLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-335-7337
Mailing Address - Street 1:1225 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9421
Mailing Address - Country:US
Mailing Address - Phone:330-335-7337
Mailing Address - Fax:330-334-8309
Practice Address - Street 1:1225 HIGH ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9421
Practice Address - Country:US
Practice Address - Phone:330-335-7337
Practice Address - Fax:330-334-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093523Medicaid