Organization
LIFESTAGES PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNIE KOTTO MD (DIRECTOR/PHYSICIAN)
(215) 935-6493
Entity
Organization
Contact information
Practice address
8080 OLD YORK RD STE 207, ELKINS PARK, PA 19027-1426
(215) 935-6493
Mailing address
8080 OLD YORK RD STE 207, ELKINS PARK, PA 19027-1426
(215) 935-6493
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025509500009
—
PA
Enumeration date
10/01/2019
Last updated
10/01/2019
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