Provider Demographics
NPI:1831171214
Name:KID C.A.R.E. CENTER, P.A.
Entity type:Organization
Organization Name:KID C.A.R.E. CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:HARRIS-CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-424-8404
Mailing Address - Street 1:771 E MASTEN CIR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1088
Mailing Address - Country:US
Mailing Address - Phone:302-424-8404
Mailing Address - Fax:302-424-0208
Practice Address - Street 1:771 E MASTEN CIR
Practice Address - Street 2:SUITE 115
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1088
Practice Address - Country:US
Practice Address - Phone:302-424-8404
Practice Address - Fax:302-424-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========OtherEIN
MDG90124Medicare UPIN