Organization
PEDIATRIC ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELISSA L MACOLLEY (BUSINESS MANAGER)
(302) 368-8612
Entity
Organization
Contact information
Practice address
4735 OGLETOWN STANTON RD, MAP 2 SUITE 1116, NEWARK, DE 19713-2072
(302) 368-8612
(302) 368-8836
Mailing address
4735 OGLETOWN STANTON RD, MAP 2 SUITE 1116, NEWARK, DE 19713-2072
(302) 368-8612
(302) 368-8836
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1989014003
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000079002
IBC GROUP
DE
01
—
0075682000
IBC GROUP
DE
01
—
75682001
AMERIHEALTH GROUP
DE
01
—
78530
AETNA GROUP
DE
Enumeration date
08/31/2006
Last updated
08/22/2020
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