Provider Demographics
NPI:1639297138
Name:URBAN PEDIATRICS
Entity type:Organization
Organization Name:URBAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-746-1901
Mailing Address - Street 1:3433 AGLER RD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3388
Mailing Address - Country:US
Mailing Address - Phone:614-476-1901
Mailing Address - Fax:614-476-8748
Practice Address - Street 1:3433 AGLER RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3387
Practice Address - Country:US
Practice Address - Phone:614-476-1901
Practice Address - Fax:614-476-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
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
OH0573991Medicaid