Provider Demographics
NPI:1801060108
Name:TOTS THRU TEENS PEDIATRICS, INC.
Entity type:Organization
Organization Name:TOTS THRU TEENS PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-291-7766
Mailing Address - Street 1:12255 DEPAUL DR.
Mailing Address - Street 2:SUITE 490
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-291-7766
Mailing Address - Fax:314-291-7767
Practice Address - Street 1:12255 DEPAUL DR.
Practice Address - Street 2:SUITE 490
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-291-7766
Practice Address - Fax:314-291-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7C02208000000X
MOR6G08208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty