Provider Demographics
NPI:1669723409
Name:COMMUNITY PEDIATRICS, INC
Entity type:Organization
Organization Name:COMMUNITY PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENAAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:KASHEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-876-1304
Mailing Address - Street 1:3966 BROWN PARK DRIVE, SUITE C
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3966 BROWN PARK DRIVE, SUITE C
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1164
Practice Address - Country:US
Practice Address - Phone:614-876-1304
Practice Address - Fax:614-876-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH076356261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care