Basic Information
| Provider Information | |||||||||
| NPI: | 1952315822 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WAYNE PEDIATRIC ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W LANCASTER AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190874043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102932229 | ||||||||
| FaxNumber: | 6102932231 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W LANCASTER AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190874043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102932229 | ||||||||
| FaxNumber: | 6102932231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MOOREVILLE | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6102932229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.