Organization
PEDIATRIC ASSOCIATES OF PAOLI, PC
Active
Other names
Pediatric Associates of Paoli
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY KIENZLE (OFFICE MANAGER)
(610) 647-1484
Entity
Organization
Contact information
Practice address
17 INDUSTRIAL BLVD, SUITE 204, PAOLI, PA 19301-1607
(610) 647-1484
(610) 647-7068
Mailing address
17 INDUSTRIAL BLVD, SUITE 204, PAOLI, PA 19301-1607
(610) 647-1484
(610) 647-7068
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
897325
BLUE SHIELD
PA
Enumeration date
03/15/2006
Last updated
11/20/2007
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