Provider Demographics
NPI:1336411594
Name:PEDIATRIC INFECTIOUS DISEASES AND TRAVEL CLINIC OF LAREDO, PA
Entity Type:Organization
Organization Name:PEDIATRIC INFECTIOUS DISEASES AND TRAVEL CLINIC OF LAREDO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADERINBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-916-9172
Mailing Address - Street 1:3826 CRESTWIND
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8190
Mailing Address - Country:US
Mailing Address - Phone:917-916-9172
Mailing Address - Fax:
Practice Address - Street 1:3826 CRESTWIND
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8190
Practice Address - Country:US
Practice Address - Phone:917-916-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN42332080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty