Provider Demographics
NPI:1740283647
Name:PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.
Entity type:Organization
Organization Name:PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:972-566-7788
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE B332
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-7788
Mailing Address - Fax:972-566-8837
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SB332
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6822
Practice Address - Country:US
Practice Address - Phone:972-566-7788
Practice Address - Fax:972-566-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200032360AMedicaid
TX0851610-02Medicaid
TX00T20WMedicare ID - Type UnspecifiedGROUP ID