Organization
JEFFERSON PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIRIDHAR VEERULA MD (PHYSICIAN)
(260) 436-7722
Entity
Organization
Contact information
Practice address
3919 W JEFFERSON BLVD, SUITE 1, FORT WAYNE, IN 46804-6811
(260) 436-7722
Mailing address
3919 W JEFFERSON BLVD, SUITE 1, FORT WAYNE, IN 46804-6811
(260) 436-7722
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004759A
IN
Other
Enumeration date
01/31/2014
Last updated
01/31/2014
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