Organization
PROVIDENCE PEDIATRICS, PC
Active
Other names
Providence Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH DEMAY MD (PRESIDENT)
(570) 326-5720
Entity
Organization
Contact information
Practice address
338 RUSSELL AVENUE, WILLIAMSPORT, PA 17701
(570) 326-5720
(570) 601-1522
Mailing address
338 RUSSELL AVENUE, WILLIAMSPORT, PA 17701
(570) 326-5720
(570) 601-1522
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD046306-L
PA
2080A0000X
Pediatric Adolescent Medicine Physician
MD046306L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012712310004
—
PA
Enumeration date
02/14/2007
Last updated
01/11/2011
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