Basic Information
| Provider Information | |||||||||
| NPI: | 1285391086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDORRA PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8945 RIDGE AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191282036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154838558 | ||||||||
| FaxNumber: | 2154871270 | ||||||||
| Practice Location | |||||||||
| Address1: | 8945 RIDGE AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191282036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154838558 | ||||||||
| FaxNumber: | 2154871270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2021 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCMASTER | ||||||||
| AuthorizedOfficialFirstName: | JANN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2154838558 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.