Organization
CHILDREN'S COMMUNITY CARE
Active
Other names
Children's Community Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MARTINEZ (EXECUTIVE ADMINISTRATOR III)
(724) 933-1100
Entity
Organization
Contact information
Practice address
3580 PEACH ST, SUITE 100, ERIE, PA 16508-2776
(814) 868-9633
Mailing address
103 BRADFORD RD STE 200, WEXFORD, PA 15090-6910
(724) 933-1100
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001641690
HIGHMARK ID#
PA
Enumeration date
08/03/2006
Last updated
09/11/2023
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