Organization
IDEAL PEDIATRIC AND ADOLESCENT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY BETH ANN O'HARA D.O. (PRESIDENT)
(570) 551-0300
Entity
Organization
Contact information
Practice address
121 JPM RD, LEWISBURG, PA 17837-9313
(570) 551-0300
Mailing address
121 JPM RD, LEWISBURG, PA 17837-9313
(570) 551-0300
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OS008495L
PA
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
Update your record
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