Provider Demographics
NPI:1356115398
Name:ORCHID DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Entity type:Organization
Organization Name:ORCHID DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHARDT DE MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-880-1334
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 5415
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE STE 5415
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:206-880-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty