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Organization
KIDS STATION PEDIATRICS
Active
Organization
KIDS STATION PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD FRANCIS MORDAVSKY MD (CEO)
(860) 643-7973
Entity
Organization
Contact information
Practice address
191 MAIN ST, MANCHESTER, CT 06042-3556
(860) 643-7973
(860) 643-0175
Mailing address
191 MAIN ST, MANCHESTER, CT 06042-3556
(860) 643-7973
(860) 643-0175
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
CT
Other
Enumeration date
06/25/2007
Last updated
10/08/2013
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