Provider Demographics
NPI:1952563470
Name:BUCKS COUNTY PEDIATRICS
Entity Type:Organization
Organization Name:BUCKS COUNTY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-443-5966
Mailing Address - Street 1:1190 OLD YORK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2050
Mailing Address - Country:US
Mailing Address - Phone:215-443-5966
Mailing Address - Fax:215-443-7813
Practice Address - Street 1:1190 OLD YORK RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2050
Practice Address - Country:US
Practice Address - Phone:215-443-5966
Practice Address - Fax:215-443-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045089L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1452380Medicaid