Provider Demographics
NPI:1740247923
Name:PEDIATRIC EDUCATIONAL & DIAGNOSTIC SERVICES, LTD
Entity type:Organization
Organization Name:PEDIATRIC EDUCATIONAL & DIAGNOSTIC SERVICES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHELAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:610-770-9111
Mailing Address - Street 1:2200 W HAMILTON ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6337
Mailing Address - Country:US
Mailing Address - Phone:610-770-9111
Mailing Address - Fax:610-770-9507
Practice Address - Street 1:2200 W HAMILTON ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6337
Practice Address - Country:US
Practice Address - Phone:610-770-9111
Practice Address - Fax:610-770-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023578E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty