Provider Demographics
NPI:1780702118
Name:PEDIATRIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-786-2491
Mailing Address - Street 1:1 GENERAL WING RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4681
Mailing Address - Country:US
Mailing Address - Phone:802-786-2491
Mailing Address - Fax:802-775-6141
Practice Address - Street 1:1 GENERAL WING RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4681
Practice Address - Country:US
Practice Address - Phone:802-786-2491
Practice Address - Fax:802-775-6141
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 Licenses
StateLicense IDTaxonomies
VT0420008063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006105Medicaid
1737OtherCDPHP
VT6105OtherVT BLUE CROSS BLUE SHIELD
NY372101Medicaid
NY372101Medicaid