Provider Demographics
NPI:1255516530
Name:PERSONAL CARE PEDIATRICS LLC
Entity type:Organization
Organization Name:PERSONAL CARE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-369-1190
Mailing Address - Street 1:2771 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-2306
Mailing Address - Country:US
Mailing Address - Phone:215-541-1333
Mailing Address - Fax:215-541-1311
Practice Address - Street 1:2771 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-541-1333
Practice Address - Fax:215-541-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070311L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH44578Medicare UPIN