Provider Demographics
NPI:1770565004
Name:AUBURN PEDIATRICS, P.C.
Entity type:Organization
Organization Name:AUBURN PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-925-3500
Mailing Address - Street 1:1314 E 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2535
Mailing Address - Country:US
Mailing Address - Phone:260-925-3500
Mailing Address - Fax:260-925-3195
Practice Address - Street 1:1314 E 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2535
Practice Address - Country:US
Practice Address - Phone:260-925-3500
Practice Address - Fax:260-925-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588678Medicaid
IN000000278359OtherANTHEM BCBS